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IVUS Guidance

Abstract

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Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures Long-term survival in patients undergoing percutaneous interventions with or without intracoronary pressure wire guidance or intracoronary ultrasonographic imaging: a large cohort study Novel predictor of target vessel revascularization after coronary stent implantation: Intraluminal intensity of blood speckle on intravascular ultrasound Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis
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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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