The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents

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Background

Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) has been demonstrated to be useful in optimizing stent deployment. However, it is not proven that routine use of IVUS guidance with (drug-eluting stent) DES implantation can prevent stent thrombosis (ST) or restenosis.

Methods

The clinical outcomes of 884 patients undergoing IVUS-guided intracoronary DES implantation from April 2003 to May 2006 were compared with a propensity score (PS)-matched group undergoing DES implantation with angiographic guidance alone. The aim of the study was definite ST at 12 months. Major adverse cardiac events (MACE) were also evaluated.

Results

After PS matching, the two groups were well matched for clinical and angiographic characteristics. Patients undergoing IVUS-guided DES implantation received longer stents, underwent less direct stenting, and more post-dilation. At 30 days and at 12 months, a higher rate of definite ST was seen in the no-IVUS group (0.5% vs. 1.4%, P=.045; and 0.7% vs. 2.0%, P=.014, respectively). There were no major differences in late ST and MACE at 12 months (14.5 vs. 16.2; P=.32) between the groups. Rates of

Conclusions

IVUS-guided DES implantation has the potential to influence treatment strategy and reduce both DES thrombosis and the need for repeat revascularization. IVUS guidance should be considered for routine use during DES implantation in patients at increased risk for these events.

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