CBS 2019
CBSMD教育中心
中 文

IVUS Guidance

Abstract

Recommended Article

Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis The impact of intravascular ultrasound guidance during drug eluting stent implantation on angiographic outcomes Usefulness of minimum stent cross sectional area as a predictor of angiographic restenosis after primary percutaneous coronary intervention in acute myocardial infarction (from the HORIZONS-AMI Trial IVUS substudy) Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis Prospective application of pre-defined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions results from the multicenter LITRO study Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study

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.