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IVUS Guidance

Abstract

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Intravascular Ultrasound-Guided Versus Angiography-Guided Implantation of Drug-Eluting Stent in All-Comers: The ULTIMATE trial IVUS Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone Intravascular imaging in coronary artery disease Optical coherence tomography is a kid on the block: I would choose intravascular ultrasound Intravascular ultrasound-guided percutaneous coronary intervention in left main coronary bifurcation lesions: a review The Year in Cardiovascular Medicine 2020: Imaging: Looking back on the Year in Cardiovascular Medicine for 2020 in the field of imaging are Fausto Pinto, José Luis Zamorano and Chiara Bucciarelli-Ducci. Judy Ozkan speaks with them Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy Intravascular ultrasound guidance in drug-eluting stents implantation: a meta-analysis and trial sequential analysis of randomized controlled trials
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Clinical TrialSeptember 2019

JOURNAL：JACC Cardiovasc Interv. Article Link

Effect of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation: Five-Year Follow-Up of the IVUS-XPL Randomized Trial

SJ Hong, GS Mintz, the IVUS-XPL Investigators. Keywords: IVUS guidance superior to angiography guidance; MACE; long-term follow-up; long lesions

ABSTRACT

OBJECTIVES - The goal of this study was to evaluate whether the beneficial effect of use of intravascular ultrasound (IVUS) is sustained for long-term follow-up.

 

BACKGROUND - The use of IVUS promoted favorable 1-year clinical outcome in the IVUS-XPL trial. It is not known, however, whether this effect is sustained for long-term follow-up.

 

METHODS - The IVUS-XPL trial randomized 1,400 patients with long coronary lesions (implanted stent length ≥28mm) to receive IVUS- (n=700) or angiography-guided (n=700) everolimus-eluting stent implantation. Five-year clinical outcomes were investigated in patients who completed the original trial. Primary outcome was the composite of major adverse cardiac events, including cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 5 years, analyzed by intention-to-treat.

 

RESULTS - Five-year follow-up was completed in 1,183 patients (85%). Major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS-guidance and in 70 patients (10.7%) receiving angiography-guidance (hazard ratio [HR]=0.50, 95% confidence interval [CI]=0.34−0.75, P=0.001). The difference was mainly driven by a lower risk of target lesion revascularization (31 [4.8%] vs. 55 [8.4%], HR=0.54; 95% CI=0.33−0.89, P=0.007). By landmark analysis, major adverse cardiac events between 1 and 5 years occurred in 17 patients (2.8%) receiving IVUS-guidance and in 31 patients (5.2%) receiving angiography-guidance (HR=0.53, 95% CI=0.29-0.95, P=0.031).

 

CONCLUSIONS - Compared with angiography-guided stent implantation, IVUS-guided stent implantation resulted in a significantly lower rate of major adverse cardiac events up to 5 years. Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years’ post-implantation.

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