Key result
IVUS-guided stenting cuts MACE to ~0% vs angiography in unprotected left main and LAD disease.
Why the study?
Angiography has limitations in evaluating coronary lesions, and the clinical and angiographic impact of IVUS guidance for stenting of unprotected left main or proximal LAD disease required evaluation.
Does IVUS-guided PCI reduce major adverse cardiac events and improve angiographic outcomes in patients with unprotected left main or proximal LAD coronary artery disease?
RCT (n=60)
Open-label
Randomized into two groups
No
Does IVUS-guided PCI reduce major adverse cardiac events and improve angiographic outcomes in patients with unprotected left main or proximal LAD coronary artery disease?
Absolute Event Rate: 0% vs 13.3%
p-value: p=0.038
IVUS-guided PCI for unprotected left main or proximal LAD lesions significantly improves angiographic results and reduces 6-month major adverse cardiac events compared to angiography guidance alone.
IVUS guidance may warrant routine use in unprotected left main/proximal LAD PCI; extends RCT evidence for imaging in complex lesions.
Kontext: KoronarografickĂŠ vyĹĄetĹenĂ mĂĄ pro ĹĂĄdnĂŠ vyhodnocenĂ lĂŠzĂ na koronĂĄrnĂch tepnĂĄch jistĂŠ limitace. PouĹžitĂ intravaskulĂĄrnĂho ultrazvuku (intravascular ultrasound, IVUS) pĹed perkutĂĄnnĂ koronĂĄrnĂ intervencĂ (PCI) mĹŻĹže odhalit vĂ˝znamnĂŠ stenĂłzy, pomĂĄhĂĄ zvolit vhodnĂ˝ stent a mĹŻĹže upozornit na moĹžnĂŠ komplikace. CĂlem studie bylo hodnotit dĹŻsledky pouĹžitĂ IVUS na klinickĂŠ a angiograficky potvrzenĂŠ vĂ˝sledky revaskularizace nechrĂĄnÄnĂŠho kmene levĂŠ vÄnÄitĂŠ tepny (unprotected left main, ULM) nebo proximĂĄlnĂ levĂŠ pĹednĂ sestupnĂŠ vÄtve (left anterior descending, LAD) pomocĂ stentu pĹi ischemickĂŠ chorobÄ srdeÄnĂ (ICHS). MateriĂĄly a metody: Byla provedena prospektivnĂ randomizovanĂĄ kontrolovanĂĄ studie s 60 pacienty se stabilnĂ anginou pectoris nebo s akutnĂm koronĂĄrnĂm syndromem bez elevacĂ Ăşseku ST. KoronarografickĂŠ vyĹĄetĹenĂ provedenĂŠ na katetrizaÄnĂm pracoviĹĄti egyptskĂŠho NĂĄrodnĂho Ăşstavu zdravĂ odhalilo vĂ˝znamnĂŠ ischemickĂŠ postiĹženĂ kmene levĂŠ vÄnÄitĂŠ tepny nebo proximĂĄlnĂ LAD. U pacientĹŻ byla indikovĂĄna revaskularizace formou PCI. PerkutĂĄnnĂ koronĂĄrnĂ intervence navigovanĂĄ koronĂĄrnĂm IVUS byla provedena u 30 pa- cientĹŻ (skupina A), zatĂmco ve skupinÄ B nebyl pĹi PCI koronĂĄrnĂ IVUS pouĹžit. ĂÄastnĂci studie byli sledovĂĄni po dobu ĹĄesti mÄsĂcĹŻ s cĂlem analyzovat primĂĄrnĂ nebo sekundĂĄrnĂ sledovanĂŠ parametry. VĂ˝sledky: Navigace pomocĂ IVUS byla spojena se statisticky vĂ˝znamnÄ vÄtĹĄĂm minimĂĄlnĂm prĹŻsvitem cĂŠv po implantaci stentu potvrzenĂ˝m kvantitativnĂ koronarografiĂ (quantitative coronary angiography, QCA) (p = 0,001), vÄtĹĄĂm prĹŻmÄrem stentu (p = 0,001) a dalĹĄĂ dilatacĂ (p = 0,02). SrovnĂĄnĂ obou skupin prokĂĄzalo, Ĺže navigace pomocĂ IVUS byla spojena se statisticky vĂ˝znamnÄ niŞťĂm vĂ˝skytem trombĂłzy stentu v cĂlovĂ˝ch lĂŠzĂch, nefatĂĄlnĂho infarktu myokardu ve vztahu k poÄtu cĂlovĂ˝ch lĂŠzĂ, s niŞťĂmi poÄty revaskularizaÄnĂch vĂ˝konĹŻ na cĂlovĂ˝ch lĂŠzĂch i s niŞťĂmi celkovĂ˝mi poÄty zĂĄvaĹžnĂ˝ch neŞådoucĂch srdeÄnĂch pĹĂhod (major adverse cardiac events, MACE) bÄhem ĹĄestimÄsĂÄnĂho sledovĂĄnĂ (p = 0,038 pro vĹĄechny uvedenĂŠ parametry). ZĂĄvÄry: ProvĂĄdÄnĂ PCI s implantacĂ stentu do ULM a proximĂĄlnĂ LAD, navigovanĂŠ pomocĂ IVUS, zlepĹĄuje klinickĂ˝ vĂ˝slednĂ˝ stav se statisticky vĂ˝znamnÄ niŞťĂm vĂ˝skytem MACE do 6 mÄsĂcĹŻ dĂky vĂ˝znamnÄ niŞťĂmu riziku revaskularizace cĂlovĂŠ lĂŠze a trombĂłzy stentu. U pacientĹŻ s ischemickĂ˝m postiĹženĂm ULM nebo proximĂĄlnĂ LAD doporuÄujeme rutinnĂ pouĹžĂvĂĄnĂ navigace pomocĂ IVUS pĹi revaskularizaci implantacĂ stentu. © 2023, ÄKS.
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Hanboly et al. (2023) conducted an RCT in Unprotected left main (ULM) or proximal left anterior descending (LAD) coronary artery disease (n=60). Intravascular ultrasound (IVUS) guided PCI vs. Angiography-guided PCI was evaluated on Major adverse cardiac events (MACE) at 6 months (p=0.038). Intravascular ultrasound-guided stenting of unprotected left main and proximal LAD coronary artery disease significantly reduced major adverse cardiac events at 6 months to 0% compared to 13.3% with angiography guidance.
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