The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents

Probal Roy, Daniel H. Steinberg, Steven J. Sushinsky, Teruo Okabe, Tina L. Pinto Slottow, Kimberly Kaneshige, Zhenyi Xue, Lowell F. Satler, Kenneth M. Kent, William O. Suddath, Augusto D. Pichard, Neil J. Weissman, Joseph Lindsay, Ron Waksman*

*Corresponding author for this work

    Research output: Contribution to journalArticle

    227 Citations (Scopus)

    Abstract

    Aims: To assess the impact on clinical outcomes of intravascular ultrasound (IVUS) guidance during drug-eluting stent (DES) implantation. IVUS guidance during percutaneous coronary intervention (PCI) has been demonstrated to be useful in optimizing stent deployment. However, it is not proved that routine use of IVUS guidance with DES implantation can prevent stent thrombosis or restenosis. Methods and results: The clinical outcomes of 884 patients undergoing IVUS-guided intracoronary DES implantation from April 2003 to May 2006 were compared with the outcomes of a propensity-score matched population undergoing DES implantation with angiographic guidance alone. The primary endpoint of the study was definite stent thrombosis at 12 months. The secondary endpoint was major adverse cardiac events (MACE). After propensity-score matching, the two groups were well matched for clinical and angiographic characteristics. Patients undergoing IVUS-guided DES implantation underwent less direct stenting, more post-dilation, and had greater cutting balloon and rotational atherectomy use. At 30 days and at 12 months, a higher rate of definite stent thrombosis was seen in the No IVUS group (0.5 vs. 1.4%; P = 0.046) and (0.7 vs. 2.0%; P = 0.014), respectively. There were no major differences in late stent thrombosis and MACE (14.5 vs. 16.2%; P = 0.33) at 12 month follow-up between the groups. Rates of death and Q-wave myocardial infarction were similar, and there was no significant difference between groups in target vessel revascularization. However, a trend was seen in favour of the IVUS group in target lesion revascularization (5.1 vs. 7.2%; P = 0.07). IVUS guidance was an independent predictor of freedom from cumulative stent thrombosis at 12 months (adjusted HR 0.5, CI 0.1-0.8; P = 0.02). Conclusion: IVUS guidance during DES implantation has the potential to influence treatment strategy and reduce both DES thrombosis and the need for repeat revascularization.

    Original languageEnglish
    Pages (from-to)1851-1857
    Number of pages7
    JournalEuropean Heart Journal
    Volume29
    Issue number15
    DOIs
    Publication statusPublished - Aug 2008

    Keywords

    • Drug-eluting stent
    • Intravascular ultrasound
    • Percutaneous coronary intervention

    Fingerprint Dive into the research topics of 'The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents'. Together they form a unique fingerprint.

    Cite this