Intravascular Ultrasound vs Aniography-Guided Stent Implantation Outcomes

Intravascular Brachytherapy for In-Stent Restenosis
Intravascular Brachytherapy for In-Stent Restenosis
Patients who underwent intravascular ultrasound guided drug-eluting stent implantation vs angiography-guided implantation had reductions in MACE.

Intravascular ultrasound (IVUS)-guided new-generation drug-eluting stent (DES) implantation is associated with favorable outcomes in patients with complex coronary lesions when compared to angiography-guided DES implantation, according to research published in JACC Cardiovascular Interventions.

Researchers from the Yonsei University Health System in Seoul, South Korea and the Cardiovascular Research Foundation in New York City conducted a meta-analysis of 3 randomized trials, published between 2005-2015 that compared IVUS-guided vs angiography-guided new-generation DES implantation. A total of 2345 patients treated for long lesions or chronic total occlusions were included.

The primary study end point was the occurrence of a major adverse cardiovascular event (MACE)—a composite of cardiac death, myocardial infarction (MI), or stent thrombosis. The secondary end point was individual components of the primary end point and target lesion revascularization.

At 1-year post implantation, 0.4% of patients included in the 3 trials who received IVUS-guided DES implantation reached the primary end point, vs 1.2% of those who received angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95% confidence interval [CI], 0.13-0.99; P =.040).

In a per-protocol analysis, results were similar: MACE occurred in 0.4% of patients in the IVUS-guided DES implantation group versus in 1.3% of patients in the angiography-guided DES implantation group (HR: 0.32; 95% CI, 0.12-0.89; P =.021). Additional favorable outcomes were observed for MI in the IVUS-guided patient group (0% vs 0.4% in the angiography-guided group; P =.026). Rates of cardiac death and stent thrombosis were not significantly different.

“[T]here was a clinical benefit apparent for the hard clinical end point variables that was revealed by the present study,” the researchers wrote, noting that use of IVUS resulted in a relative risk reduction of 64% for MACE. “Despite the use of new-generation DESs, complex lesions still have been associated with worse clinical outcomes.”

Study Limitations

  • The included trials only enrolled patients with complex coronary lesions, therefore external generalizability is limited.
  • A follow-up period of 1 year may be insufficient for assessment of long-term clinical outcomes.

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Shin D-H, Hong S-J, Mintz GS, et al. Effects of intravascular ultrasound-guided versus angiography-guided new-generation drug-eluting stent implantation: meta-analysis with individual patient-level data from 2345 randomized patients. JACC Cardiovasc Interv. 2016. doi:10.1016/j.jcin.2016.07.021 [Epub ahead of print].