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'Ticagrelor alone vs. dual antiplatelet therapy from 1 month after drug-eluting coronary stenting among patients with STEMI': a post hoc analysis of the randomized GLOBAL LEADERS trial Comparison of 1-month Versus 12-month Dual Antiplatelet Therapy after Implantation of Drug-eluting Stents Guided by either Intravascular Ultrasound or Angiography in Patients with Acute Coronary Syndrome: Rationale and Design of Prospective, Multicenter, Randomized, Controlled IVUS-ACS & ULTIMATE-DAPT trial Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Multivessel PCI Rationale and design of the comparison between a P2Y12 inhibitor monotherapy versus dual antiplatelet therapy in patients undergoing implantation of coronary drug-eluting stents (SMART-CHOICE): A prospective multicenter randomized trial Trial Design Principles for Patients at High Bleeding Risk Undergoing PCI: JACC Scientific Expert Panel A Platelet Function Modulator of Thrombin Activation Is Causally Linked to Cardiovascular Disease and Affects PAR4 Receptor Signaling Rationale and design of a prospective substudy of clinical endpoint adjudication processes within an investigator-reported randomised controlled trial in patients with coronary artery disease: the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY)

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Original Research2013 Aug 10;167(3):721-6.

JOURNAL：Int J Cardiol. Article Link

Impact of intravascular ultrasound guidance in routine percutaneous coronary intervention for conventional lesions: data from the EXCELLENT trial

Park KW, Kang SH, Yang HM et al. Keywords: Coronary artery disease; Coronary intervention; Drug-eluting stent; Intravascular ultrasound; Stent

ABSTRACT

BACKGROUND - Intravascular ultrasound (IVUS) offers tomographic images of coronary artery, helping physicians refine percutaneous coronary intervention (PCI) procedures. However, it is still controversial whether routine use of IVUS in conventional lesions leads to improvement in clinical outcomes after PCI.

METHODS - From the EXCELLENT trial, patients were grouped into IVUS-guided versus IVUS-non-guided PCI (619 and 802 patients, respectively). The crude patients as well as the propensity score matched pairs were compared with regard to clinical outcomes.

RESULTS - Baseline characteristics showed younger age and lower incidence of comorbidities in the IVUS group. IVUS-guided PCI was associated with more aggressive treatment such as longer stenting length, larger stent diameter, and greater number of stents implanted. In the total population, IVUS guidance was associated with a significantly higher risk of periprocedural MI with no significant differences in other outcomes. In the matched cohort (463 matched pairs, 926 patients), IVUS guidance was associated with significantly increased risk of target lesion failure (4.3% vs. 2.4%; p=0.047 by conditional logistic regression) and major adverse cardiovascular events at 1 year almost exclusively due to increased risk of periprocedural myocardial infarction (MI) (1.6% vs. 0.2%; p=0.050), while the rates of cardiac death, spontaneous MI, and target lesion revascularization did not differ significantly between the two groups.

CONCLUSIONS - The adjunctive use of IVUS during PCI was associated with more stents implanted, longer stenting, and bigger stenting. There were no significant advantages of IVUS guidance, but rather a significant increase in periprocedural enzyme elevation, reflecting more aggressive procedures performed with IVUS guidance.

Abstract

Recommended Article

Impact of intravascular ultrasound guidance in routine percutaneous coronary intervention for conventional lesions: data from the EXCELLENT trial

ABSTRACT