Two-Year ADAPT-DES Data Examine Relationship of IVUS Guidance on DES Outcomes

November 16, 2018—Two-year follow-up data from the large-scale ADAPT-DES study assessing dual-antiplatelet therapy with drug-eluting stents (DESs) implanted with intravenous ultrasound (IVUS) guidance were published by Akiko Maehara, MD, et al online ahead of print in Circulation: Cardiovascular Interventions. The study had previously shown that IVUS-guided DES implantation was associated with a reduction in 1-year rates of stent thrombosis, myocardial infarction (MI), and major adverse cardiac events (MACE; defined as cardiac death, MI, or stent thrombosis) compared with angiography guidance alone.

The prospective, multicenter, nonrandomized all-comers study of 8,582 consecutive patients at 11 sites in the United States and Germany was designed to determine the frequency, timing, and correlates of adverse events after DES.

The investigators now sought to determine whether the benefits of IVUS guidance were maintained, reduced, or increased at 2 years.

As summarized in Circulation: Cardiovascular Interventions, the investigators performed a propensity-adjusted multivariable analysis to examine the impact of IVUS guidance on 2-year outcomes.

The investigators reported that IVUS guidance (n = 3,361; 39%) compared with angiography guidance (n = 5,221; 61%) was associated with reduced 2-year adjudicated rates of the following:

• MACE (4.9% vs 7.5%; adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.59–0.89; P = .003),
• Definite/probable stent thrombosis (0.55% vs 1.16%; adjusted HR, 0.4; 95% CI, 0.22–0.73; P = .003)
• MI (3.5% vs 5.6%; adjusted HR, 0.65; 95% CI, 0.51–0.83; P = .0006).

By landmark analysis, IVUS guidance compared with angiography guidance was also associated with significantly reduced rates of MACE, MI, stent thrombosis, and clinically driven target lesion revascularization between 1 and 2 years after DES implantation. The average number needed to treat with IVUS guidance to prevent one MACE was reduced from 64 (42–137) at 1 year to 41 (29–69) at 2 years.

In ADAPT-DES, the early improvement in event-free survival after DES implantation with IVUS guidance compared with angiography guidance was further increased with the longer-term follow-up to 2 years, concluded the investigators in Circulation: Cardiovascular Interventions.