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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
Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden..
Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden..
Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden..
Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden..
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2017 (English)In: Circulation. Cardiovascular Interventions, ISSN 1941-7640, E-ISSN 1941-7632, Vol. 10, no 5, e004813Article in journal (Refereed) Published
Abstract [en]

Background: Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study.

Methods and Results: Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Of 2468 patients, IVUS guidance was used in 621 (25.2%). The IVUS group was younger (median age, 70 versus 75 years) and had fewer comorbidities but more complex lesions. IVUS was associated with larger stent diameters (median, 4 mm versus 3.5 mm). After adjusting for potential confounders, IVUS was associated with significantly lower occurrence of the primary composite end point of all-cause mortality, restenosis, or definite stent thrombosis (hazard ratio, 0.65; 95% confidence interval, 0.50-0.84) and all-cause mortality alone (hazard ratio, 0.62; 95% confidence interval, 0.47-0.82). In 340 propensity score-matched pairs, IVUS was also associated with significantly lower occurrence of the primary end point (hazard ratio, 0.54; 95% confidence interval, 0.37-0.80).

Conclusions: IVUS was associated with an independent and significant outcome benefit when performing unprotected LMCA PCI. Potential mediators of this benefit include larger and more appropriately sized stents, perhaps translating into lower risk of subsequent stent thrombosis. Although residual confounding cannot be ruled out, our findings indicate a possible hazard when performing unprotected LMCA PCI without IVUS guidance.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2017. Vol. 10, no 5, e004813
Keyword [en]
acute coronary syndrome, angioplasty, comorbidity, percutaneous coronary intervention, thrombosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-324620DOI: 10.1161/CIRCINTERVENTIONS.116.004813ISI: 000401546000010OAI: oai:DiVA.org:uu-324620DiVA: diva2:1111867
Funder
Swedish Heart Lung FoundationSwedish Research CouncilSwedish Foundation for Strategic Research Knut and Alice Wallenberg FoundationRegion Skåne
Available from: 2017-06-19 Created: 2017-06-19 Last updated: 2017-06-19Bibliographically approved

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