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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 TrialOctober 2020

JOURNAL：JACC: Cardiovascular Interventions Article Link

Three-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation

XF Gao, Z Ge, and for the ULTIMATE Investigators et al. Keywords: IVUS-guided DES-PCI; all-comers; TVF

ABSTRACT

OBJECTIVES - This study aimed to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiography guidance for all-comers undergoing second-generation drug-eluting stent (DES) implantation.

BACKGROUND - The multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions) trial showed fewer 1-year TVFs after IVUS-guided DES implantation for all-comers compared with those after angiography guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown.

METHODS - A total of 1448 all-comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiography guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk of TVF at 3 years. The safety endpoint was definite / probable stent thrombosis (ST).

RESULTS - At 3 years, TVF occurred in 47 (6.6%) patients in the IVUS-guided group and in 76 (10.7%) patients in the angiography-guided group (p = 0.01), mainly driven by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%, p = 0.05). The definite or probable ST rate was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure.

CONCLUSIONS - IVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during a 3-year follow-up in all-comers, particularly for patients who underwent the IVUS-defined optimal procedure, compared with those with angiography guidance.

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