IVUS guidance was associated with reduced 1-year rates of major adverse cardiac events compared with angiography guidance (3.1% vs 4.7%; adjusted HR 0.70; 95% CI 0.55-0.88; P=0.002).
Cohort (n=8,583)
Sí
Does intravascular ultrasound (IVUS) guidance reduce major adverse cardiac events in patients undergoing drug-eluting stent implantation compared to angiography guidance?
In an unrestricted 'all-comers' population, IVUS guidance during DES implantation was associated with significantly lower 1-year rates of stent thrombosis, MI, and MACE compared to angiography guidance.
Estimación del efecto: adjusted HR 0.70 (95% CI 0.55-0.88)
Tasa de eventos absoluta: 3.1% vs 4.7%
valor p: p=0.002
BACKGROUND: Prior small to modest-sized studies suggest a benefit of intravascular ultrasound (IVUS) guidance in noncomplex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown. METHODS AND RESULTS: Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter, nonrandomized "all-comers" study of 8583 consecutive patients at 11 international centers designed to determine the frequency, timing, and correlates of stent thrombosis and adverse clinical events after DES. Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes. IVUS was utilized in 3349 patients (39%), and larger-diameter devices, longer stents, and/or higher inflation pressures were used in 74% of IVUS-guided cases. IVUS guidance compared with angiography guidance was associated with reduced 1-year rates of definite/probable stent thrombosis (0.6% 18 events versus 1.0% 53 events; adjusted hazard radio, 0.40; 95% confidence interval, 0.21-0.73; P=0.003), myocardial infarction (2.5% versus 3.7%; adjusted hazard radio, 0.66; 95% confidence interval, 0.49-0.88; P=0.004), and composite adjudicated major adverse cardiac events (ie, cardiac death, myocardial infarction, or stent thrombosis) (3.1% versus 4.7%; adjusted hazard radio, 0.70; 95% confidence interval, 0.55-0.88; P=0.002). The benefits of IVUS were especially evident in patients with acute coronary syndromes and complex lesions, although significant reductions in major adverse cardiac events were present in all patient subgroups those with including stable angina and single-vessel disease. CONCLUSIONS: In ADAPT-DES, the largest study of IVUS use to date, IVUS guidance was associated with a reduction in stent thrombosis, myocardial infarction, and major adverse cardiac events within 1 year after DES implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Witzenbichler et al. (Wed,) conducted a cohort in Drug-eluting stent implantation (n=8,583). Intravascular ultrasound (IVUS) guidance vs. Angiography guidance was evaluated on Composite adjudicated major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) (adjusted HR 0.70, 95% CI 0.55-0.88, p=0.002). IVUS guidance was associated with reduced 1-year rates of major adverse cardiac events compared with angiography guidance (3.1% vs 4.7%; adjusted HR 0.70; 95% CI 0.55-0.88; P=0.002).