Clinical Impact of Intravascular Ultrasound Guidance in Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Disease Pooled Analysis at the Patient-Level of 4 Registries

被引：174

作者：

de la Torre Hernandez, Jose M. ^{[1
]}

Baz Alonso, Jose A. ^{[2
]}

Gomez Hospital, Joan A. ^{[3
]}

Alfonso Manterola, Fernando ^{[4
]}

Garcia Camarero, Tamara ^{[1
]}

Gimeno de Carlos, Federico ^{[5
]}

Roura Ferrer, Gerard ^{[3
]}

Sanchez Recalde, Angel ^{[6
]}

Lozano Martinez-Luengas, Inigo ^{[7
]}

Gomez Lara, Josep ^{[3
]}

Hernandez Hernandez, Felipe ^{[8
]}

Perez-Vizcayno, Maria J. ^{[4
]}

Cequier Fillat, Angel ^{[3
]}

Perez de Prado, Armando ^{[9
]}

Albarran Gonzalez-Trevilla, Agustin ^{[8
]}

Jimenez Navarro, Manuel F. ^{[10
]}

Mauri Ferre, Josepa ^{[11
]}

Fernandez Diaz, Jose A. ^{[12
]}

Pinar Bermudez, Eduardo ^{[13
]}

Zueco Gil, Javier ^{[1
]}

机构：

[1] Hosp Marques de Valdecilla, Unidad Cardiol Intervencionista, Serv Cardiol, Santander, Spain

[2] Hosp Meixoeiro, Serv Cardiol, Unidad Cardiol Intervencionista, Vigo, Spain

[3] Bellvitge Hosp, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain

[4] Hosp Clin San Carlos, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain

[5] Hosp Valladolid, Serv Cardiol, Unidad Cardiol Intervencionista, Valladolid, Spain

[6] Hosp La Paz, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain

[7] Univ Oviedo, Hosp Cent Asturias, Unidad Cardiol Intervencionista, Serv Cardiol, E-33080 Oviedo, Spain

[8] Hosp 12 Octubre, Serv Cardiol, Unidad Cardiol Intervencionista, E-28041 Madrid, Spain

[9] Hosp Leon, Serv Cardiol, Unidad Cardiol Intervencionista, Leon, Spain

[10] Hosp Virgen de la Victoria, Serv Cardiol, Unidad Cardiol Intervencionista, Malaga, Spain

[11] Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Unidad Cardiol Intervencionista, Badalona, Spain

[12] Hosp Puerta de Hierro, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain

[13] Hosp Virgen Arrixaca, Serv Cardiol, Unidad Cardiol Intervencionista, Murcia, Spain

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2014年 / 7卷 / 03期

关键词：

drug-eluting stent(s); intravascular ultrasound; left main coronary artery; ARTERY-BYPASS GRAFT; LONG-TERM MORTALITY; FOLLOW-UP; REVASCULARIZATION REGISTRY; SYNTAX TRIAL; INTERVENTION; STENOSIS; OUTCOMES; SURGERY; TAXUS;

D O I：

10.1016/j.jcin.2013.09.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to investigate the clinical impact of the use of intravascular ultrasound (IVUS) during revascularization of patients with left main coronary artery (LM) disease with drug-eluting stents (DES). Background Whether the use of IVUS during the procedure adds a clinical benefit remains unclear. There is only 1 previous observational study, with relevant limitations, supporting the value of this strategy. Methods We performed a patient-level pooled analysis of 4 registries of patients with LM disease treated with DES in Spain. A propensity score-matching method was used to obtain matched pairs of patients with and without IVUS guidance. Results A total of 1,670 patients were included, and 505 patients (30.2%) underwent DES implantation under IVUS guidance (IVUS group). By means of the matching method, 505 patients without the use of IVUS during revascularization were selected (no-IVUS group). Survival free of cardiac death, myocardial infarction, and target lesion revascularization at 3 years was 88.7% in the IVUS group and 83.6% in the no-IVUS group (p = 0.04) for the overall population, and 90% and 80.7%, respectively (p = 0.03), for the subgroups with distal LM lesions. The incidence of definite and probable thrombosis was significantly lower in the IVUS group (0.6% vs. 2.2%; p = 0.04). Finally, IVUS-guided revascularization was identified as an independent predictor for major adverse events in the overall population (hazard ratio: 0.70, 95% confidence interval: 0.52 to 0.99; p = 0.04) and in the subgroup with distal lesions (hazard ratio: 0.54, 95% confidence interval: 0.34 to 0.90; p = 0.02). Conclusions The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES. (C) 2014 by the American College of Cardiology Foundation

引用

页码：244 / 254

页数：11

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