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Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry.
MedLine Citation:
PMID:  21701872     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. METHODS: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. RESULTS: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). CONCLUSIONS: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.
Authors:
Giuseppe Biondi-Zoccai; Imad Sheiban; Enrico Romagnoli; Stefano De Servi; Corrado Tamburino; Antonio Colombo; Francesco Burzotta; Patrizia Presbitero; Leonardo Bolognese; Leonardo Paloscia; Paolo Rubino; Gennaro Sardella; Carlo Briguori; Luigi Niccoli; Gianfranco Franco; Domenico Di Girolamo; Luigi Piatti; Cesare Greco; Davide Capodanno; Giuseppe Sangiorgi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-24
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  -     ISSN:  1861-0692     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy, gbiondizoccai@gmail.com.
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