Key result
IVUS guidance during drug-eluting stent implantation was associated with reduced 2-year major adverse cardiac events compared with angiography guidance (HR 0.72; 95% CI 0.59-0.89; P=0.003).
Why the study?
Does intravascular ultrasound (IVUS) guidance reduce major adverse cardiac events compared to angiography guidance alone in patients undergoing drug-eluting stent implantation?
Cohort (n=8,582)
Yes
Does intravascular ultrasound (IVUS) guidance reduce major adverse cardiac events compared to angiography guidance alone in patients undergoing drug-eluting stent implantation?
Hazard Ratio: 0.72 (95% CI 0.59–0.89)
Absolute Event Rate: 4.9% vs 7.5%
Number Needed to Treat: 41
p-value: p=0.003
IVUS guidance during drug-eluting stent implantation is associated with a sustained and increasing reduction in major adverse cardiac events, myocardial infarction, and stent thrombosis up to 2 years compared to angiography guidance alone.
Supports IVUS guidance in DES implantation; extends observational data but leaves open need for RCT confirmation.
Background In the large-scale ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), drug-eluting stent implantation with intravascular ultrasound (IVUS) guidance was associated with a reduction in 1-year rates of stent thrombosis, myocardial infarction (MI), and major adverse cardiac events (cardiac death, MI, or stent thrombosis) compared with angiography guidance alone. We assessed whether the benefits of IVUS guidance were maintained, reduced, or increased at 2 years. Methods and Results ADAPT-DES was a prospective, multicenter, nonrandomized all-comers study of 8582 consecutive patients at 11 US and German sites designed to determine the frequency, timing, and correlates of adverse events after drug-eluting stents. Propensity-adjusted multivariable analysis was performed to examine the impact of IVUS guidance on 2-year outcomes. IVUS guidance (n=3361; 39%) compared with angiography guidance (n=5221; 61%) was associated with reduced 2-year adjudicated rates of (1) major adverse cardiac events (cardiac death, MI, or stent thrombosis; 4.9% versus 7.5%; adjusted hazard ratio, 0.72; 95% CI, 0.59-0.89; P=0.003), (2) definite/probable stent thrombosis (0.55% versus 1.16%; adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P=0.003), and (3) MI (3.5% versus 5.6%; adjusted hazard ratio, 0.65; 95% CI, 0.51-0.83; P=0.0006). By landmark analysis, IVUS guidance compared with angiography guidance was also associated with significantly reduced rates of major adverse cardiac events, MI, stent thrombosis, and clinically driven target lesion revascularization between 1 and 2 years after drug-eluting stent implantation. The number needed to treat with IVUS guidance to prevent 1 major adverse cardiac event was reduced from 64 (42-137) at 1 year to 41 (29-69) at 2 years. Conclusions In ADAPT-DES, the early improvement in event-free survival after drug-eluting stent implantation with IVUS guidance compared with angiography guidance was further increased with longer term follow-up to 2 years. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT00638794.
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Maehara et al. (2018) conducted a cohort in Patients undergoing drug-eluting stent implantation (n=8,582). Intravascular ultrasound (IVUS) guidance vs. Angiography guidance alone was evaluated on Major adverse cardiac events (cardiac death, MI, or stent thrombosis) (adjusted HR 0.72, 95% CI 0.59-0.89, p=0.003). IVUS guidance during drug-eluting stent implantation was associated with reduced 2-year major adverse cardiac events compared with angiography guidance (HR 0.72; 95% CI 0.59-0.89; P=0.003).
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