1. Long-Term Clinical Impact of Intravascular Ultrasound Guidance in Stenting for Left Main Coronary Artery Disease
- Author
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Pil Hyung Lee, Do-Yoon Kang, Sang-Cheol Cho, Seong-Wook Park, Hanbit Park, Sung-Cheol Yun, Duk-Woo Park, Seung-Whan Lee, Seung-Jung Park, Jung-Min Ahn, Tae Oh Kim, and Sangwoo Park
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Coronary Artery Disease ,Coronary disease ,medicine.disease ,Coronary Angiography ,Term (time) ,Percutaneous Coronary Intervention ,Treatment Outcome ,Internal medicine ,Intravascular ultrasound ,medicine ,Cardiology ,Humans ,Stents ,Myocardial infarction ,Left main coronary artery disease ,Cardiology and Cardiovascular Medicine ,business ,Ultrasonography, Interventional - Abstract
Background: Compared with angiographic guidance, intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes. However, its very long-term clinical effect is still unclear in patients undergoing PCI for unprotected left main coronary artery disease. Methods: To compare 10-year outcomes of IVUS-guided versus angiography-guided PCI for left main coronary artery disease, we evaluated 975 patients who underwent unprotected left main coronary artery PCI between January 2000 and June 2006 from the MAIN-COMPARE (The Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry. The 10-year rates of clinical outcomes (death; the composite of death, Q-wave myocardial infarction [MI], or stroke; and target-vessel revascularization) were compared between IVUS guidance and angiography guidance. Adjusted analyses were performed with the use of inverse-probability-treatment-weighting and propensity score matching. Results: Among the 975 patients, 756 (77.5%) had IVUS guidance. The observed 10-year incidence rate of death (16.4% versus 31.0%, P P P =0.41). After adjusting for potential confounders with inverse-probability-treatment-weighting, IVUS was associated with lower incidence of mortality (hazard ratio, 0.75 [95% CI, 0.55–1.03]; P =0.07) and composite of death, Q-wave MI, or stroke (hazard ratio, 0.79 [95% CI, 0.59–1.06]; P =0.11). In 208 propensity score–matched pairs, IVUS was also associated with lower incidence of death (hazard ratio, 0.73 [95% CI, 0.53–1.02]; P =0.07) and composite outcome of death, Q-wave MI, or stroke (hazard ratio, 0.71 [95% CI, 0.52–0.97]; P =0.03). The benefit of IVUS-guided PCI was consistent in the various subsets of clinical and anatomic characteristics. Conclusions: In patients undergoing PCI for unprotected left main coronary artery disease, IVUS-guided PCI compared with angiography-guided PCI was associated with lower long-term (10-year) risks of morality and composite of death, Q-wave MI, or stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02791412.
- Published
- 2021