Impact of intravascular ultrasound‐guided percutaneous coronary intervention on long‐term clinical outcomes in a real world population. Issue 3 (9th April 2012)

• Record Type: Journal Article
• Authors: Hur, Seung‐Ho; Kang, Soo‐Jin; Kim, Young‐Hak; Ahn, Jung‐Min; Park, Duk‐Woo; Lee, Seung‐Whan; Yun, Sung‐Cheol; Lee, Cheol Whan; Park, Seong‐Wook; Park, Seung‐Jung
• Is Part Of: Catheterization and cardiovascular interventions. Volume 81:Issue 3(2013:Feb. 15)
• Page Start: 407
• Page End: 416
• Publication Date: 2012-04-09
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.23279
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p> <underline>Objectives</underline>: To compare long‐term clinical outcomes between intravascular ultrasound (IVUS)‐guided and angiography‐guided percutaneous coronary intervention (PCI) in a large "real world" registry. <underline>Background</underline>: The impact of IVUS‐guided PCI on clinical outcomes remains unclear. <underline>Methods</underline>: Between January 1998 and February 2006, 8, 371 patients who underwent IVUS‐ (<italic>n</italic> = 4, 627) or angiography‐ (<italic>n</italic> = 3, 744) guided PCI were consecutively enrolled. Three‐year clinical outcomes were compared after adjustment for inverse‐probability‐of‐treatment weighting (IPTW) in the overall population and in separate populations according to stent type. <underline>Results</underline>: A crude analysis of the overall population showed that the 3‐year mortality rate was significantly lower in the IVUS‐guided group than in the angiography‐guided group (96.4% ± 0.3% vs. 93.6% ± 0.4%, log‐rank <italic>P</italic> < 0.001). When adjusted by IPTW, patients undergoing IVUS‐guided PCI remained at lower risk of mortality (hazard ratio [HR] 0.627; 95% CI 0.50–0.79, <italic>P</italic> < 0.001). Similarly, in the drug‐eluting stent (DES) population, the 3‐year risk of mortality was significantly lower in patients undergoing IVUS‐guided PCI (HR 0.46; 95% CI 0.33–0.66, <italic>P</italic> < 0.001). In contrast, IVUS‐guided PCI did not reduce the risk of mortality in the bare metal stent population (HR 0.82; 95% CI 0.60–1.10, <italic>P</italic> = 0.185). However, the risks of myocardial infarction (HR 0.95; 95% CI 0.63–1.44, <italic>P</italic> = 0.810), target vessel revascularization (HR 1.00; 95% CI 0.86–1.15, <italic>P</italic> = 0.944), and stent thrombosis (HR 0.82; 95% CI 0.53–1.07, <italic>P</italic> = 0.109) were not associated with IVUS guidance. <underline>Conclusions</underline>: IVUS‐guided PCI may reduce long‐term mortality when compared with conventional angiography‐guided PCI. This may encourage the routine use of IVUS for PCI in patients undergoing DES implantation. © 2012 Wiley Periodicals, Inc.</p> </abstract>