Clinical impact of intravascular ultrasound guidance in drug-eluting stent implantation for unprotected left main coronary disease: pooled analysis at the patient-level of 4 registries.
JACC Cardiovasc Interv
; 7(3): 244-54, 2014 Mar.
Article
em En
| MEDLINE
| ID: mdl-24650399
ABSTRACT
OBJECTIVES:
This study sought to investigate the clinical impact of the use of intravascular ultrasound (IVUS) during revascularization of patients with left main coronary artery (LM) disease with drug-eluting stents (DES).BACKGROUND:
Whether the use of IVUS during the procedure adds a clinical benefit remains unclear. There is only 1 previous observational study, with relevant limitations, supporting the value of this strategy.METHODS:
We performed a patient-level pooled analysis of 4 registries of patients with LM disease treated with DES in Spain. A propensity score-matching method was used to obtain matched pairs of patients with and without IVUS guidance.RESULTS:
A total of 1,670 patients were included, and 505 patients (30.2%) underwent DES implantation under IVUS guidance (IVUS group). By means of the matching method, 505 patients without the use of IVUS during revascularization were selected (no-IVUS group). Survival free of cardiac death, myocardial infarction, and target lesion revascularization at 3 years was 88.7% in the IVUS group and 83.6% in the no-IVUS group (p = 0.04) for the overall population, and 90% and 80.7%, respectively (p = 0.03), for the subgroups with distal LM lesions. The incidence of definite and probable thrombosis was significantly lower in the IVUS group (0.6% vs. 2.2%; p = 0.04). Finally, IVUS-guided revascularization was identified as an independent predictor for major adverse events in the overall population (hazard ratio 0.70, 95% confidence interval 0.52 to 0.99; p = 0.04) and in the subgroup with distal lesions (hazard ratio 0.54, 95% confidence interval 0.34 to 0.90; p = 0.02).CONCLUSIONS:
The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Sistema de Registros
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Ultrassonografia de Intervenção
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Implante de Prótese Vascular
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Cirurgia Assistida por Computador
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Stents Farmacológicos
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Revascularização Miocárdica
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
Limite:
Aged
/
Female
/
Humans
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Male
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article