Key result
IVUS-guided DES implantation cuts 12-month target-vessel failure ~47% vs. angiography guidance.
Why the study?
The beneficial effect of IVUS guidance over angiography guidance on major adverse cardiovascular events in all-comer patients undergoing DES implantation remains understudied.
Does IVUS-guided DES implantation reduce target-vessel failure at 12 months in all-comer patients requiring DES implantation compared with angiography guidance?
RCT (n=1,448)
1:1 ratio
Does IVUS-guided DES implantation reduce target-vessel failure at 12 months in all-comer patients requiring DES implantation compared with angiography guidance?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In view of the evidence from randomized trials, it is time to overcome the barriers, including cost, availability, expertise, and procedure prolongation, to promote IVUS use in daily clinical practice.”
“we really should... shift our thought process to using more IVUS guidance for our patients across the board.”
“this is a great example of how imaging can really guide better procedures.... Again and again and again, we see better outcomes with IVUS-guided studies.”
IVUS-guided DES implantation significantly reduces target-vessel failure at 12 months compared to angiography guidance in an all-comer patient population.
BACKGROUND: Intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation is associated with fewer major adverse cardiovascular events compared with angiography guidance for patients with individual lesion subset. However, the beneficial effect on major adverse cardiovascular event outcome of IVUS guidance over angiography guidance in all-comers who undergo DES implantation still remains understudied. OBJECTIVES: This study aimed to determine the benefits of IVUS guidance over angiography guidance during DES implantation in all-comer patients. METHODS: A total of 1,448 all-comer patients who required DES implantation were randomly assigned (1:1 ratio) to either an IVUS guidance or angiography guidance group. The primary endpoint was target-vessel failure (TVF) at 12 months, including cardiac death, target-vessel myocardial infarction, and clinically driven target-vessel revascularization (TVR). The procedure was defined as a success if all IVUS-defined optimal criteria were met. RESULTS: At 12 months follow-up, 60 TVFs (4.2%) occurred, with 21 (2.9%) in the IVUS group and 39 (5.4%) in the angiography group (hazard ratio [HR]: 0.530; 95% confidence interval [CI]: 0.312 to 0.901; p = 0.019). In the IVUS group, TVF was recorded in 1.6% of patients with successful procedures, compared with 4.4% in patients who failed to achieve all optimal criteria (HR: 0.349; 95% CI: 0.135 to 0.898; p = 0.029). The significant reduction of clinically driven target-lesion revascularization or definite stent thrombosis (HR: 0.407; 95% CI: 0.188 to 0.880; p = 0.018) based on lesion-level analysis by IVUS guidance was not achieved when the patient-level analysis was performed. CONCLUSIONS: The present study demonstrates that IVUS-guided DES implantation significantly improved clinical outcome in all-comers, particularly for patients who had an IVUS-defined optimal procedure, compared with angiography guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions [ULTIMATE]; NCT02215915).
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2018) conducted an RCT in Coronary lesions requiring drug-eluting stent implantation (n=1,448). Intravascular ultrasound (IVUS) guidance vs. Angiography guidance was evaluated on Target-vessel failure (TVF) at 12 months, including cardiac death, target-vessel myocardial infarction, and clinically driven target-vessel revascularization (HR 0.530, 95% CI 0.312 to 0.901, p=0.019). Intravascular ultrasound-guided DES implantation reduced target-vessel failure at 12 months compared with angiography guidance (2.9% vs 5.4%; HR 0.530; 95% CI 0.312-0.901; P=0.019).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:
More on Coronary artery diseaseMore from Journal of the American College of Cardiology