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April 2, 2019

Study Supports IVUS-Guided PCI for Complex Coronary Lesions

April 2, 2019—Among patients with complex coronary artery lesion, percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) was associated with lower long-term risk of cardiac death and adverse cardiac events compared with angiography-guided PCI; therefore, IVUS guidance should be actively considered for complex PCI, concluded Ki Hong Choi, MD, et al in findings from a study published in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2019;12:607–620).

In the study, a total of 6,005 patients undergoing PCI for complex lesions with drug-eluting stents were enrolled from a prospective institutional registry from March 2003 through December 2015. All enrolled patients had at least one complex lesion (defined as bifurcation, chronic total occlusion, left main disease, long lesion, multivessel PCI, multiple stent implantation, in-stent restenosis, or heavily calcified lesion). Patients were classified according to the use of IVUS or not. To adjust baseline differences, the investigators performed multiple sensitivity analyses, including multivariable adjustment, propensity-score matching, and inverse-probability–weighted method.

As summarized in JACC: Cardiovascular Interventions, IVUS was used during complex PCI in 1,674 (27.9%) patients. The IVUS-guided PCI group had a significantly larger mean stent diameter (3.2 ± 0.4 vs 3.0 ± 0.4; P < .001), and more frequent use of postdilatation (49% vs 17.9%; P < .001) compared with the angiography-guided PCI group.

IVUS-guided PCI was associated with a significantly lower risk of cardiac death during 64 months of median follow-up compared with angiography-guided PCI (10.2% vs 16.9%; hazard ratio, 0.573; 95% confidence interval, 0.460–0.714; P < .001).

Results were consistent after multivariable regression, propensity-score matching, and inverse-probability–weighted method. The risks of all-cause death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, and major adverse cardiac events were also significantly lower in the IVUS-guided PCI group, reported the investigators in JACC: Cardiovascular Interventions.

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