What does this research mean for the field?

IVUS-guided percutaneous coronary intervention with second-generation drug-eluting stents is associated with a significantly lower long-term risk of cardiac death or myocardial infarction compared to angiography-guided PCI, regardless of lesion complexity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 17, 2022Scientific ReportsOpen Access

Use of intravascular ultrasound and long-term cardiac death or myocardial infarction in patients receiving current generation drug-eluting stents

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Why the study?

Long-term follow-up data on the differential effects of IVUS according to lesion complexity were limited in patients undergoing PCI.

Does IVUS-guided PCI reduce the risk of cardiac death or MI in patients undergoing PCI with second-generation DES compared to angiography-guided PCI?

Structured PICO

Does IVUS-guided PCI reduce the risk of cardiac death or MI in patients undergoing PCI with second-generation DES compared to angiography-guided PCI?

Population

5,488 patients undergoing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) from an institutional registry of Samsung Medical Center

Intervention

Intravascular ultrasound (IVUS)-guided PCI

Comparator

Angiography-guided PCI

Outcome

Composite of cardiac death or myocardial infarction (MI) during median 46 months follow-upcomposite

IVUS-guided PCI with second-generation DES is associated with a significantly lower long-term risk of cardiac death or MI compared to angiography guidance, regardless of lesion complexity.

Implication

Supports IVUS consideration in second-generation DES PCI; leaves open need for randomized confirmation of cardiac death or MI benefit.

Abstract

Long-term follow-up data on differential effects of intravascular ultrasound (IVUS) according to lesion complexity are limited in patients undergoing percutaneous coronary intervention (PCI). The current study compared long-term clinical outcomes between IVUS-guided and angiography-guided PCI in patients with second-generation drug-eluting stents (DES). Between February 2008 and December 2015, 5488 patients undergoing PCI with second-generation DES were recruited from an institutional registry of Samsung Medical Center. The primary outcome was a composite of cardiac death or myocardial infarction (MI) during 46 months of median follow-up (interquartile range: 32–102 months). IVUS-guided PCI was performed in 979 patients (17.8%). IVUS-guided PCI was associated with a significantly lower risk of cardiac death or MI compared with angiography-guided PCI (5.7% vs. 12.9%, hazard ratio 0.408, 95% confidence interval 0.284–0.587, p < 0.001). Results were consistent after propensity score matching analysis with 801 matched pairs. In subgroup analysis, there was no significant interaction between lesion complexity (defined by complex procedures, P interaction = 0.819, ACC/AHA lesion classification, P interaction = 0.401 or SYNTAX score, P interaction = 0.149) and use of IVUS for risk of cardiac death or MI. IVUS-guided second-generation DES implantation was associated with a significantly lower long-term risk of cardiac death or MI compared with angiography guidance, regardless of lesion complexity.