title: Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis.
abstract: BACKGROUND
  Although intravascular ultrasound (IVUS) guidance has been useful in stenting for unprotected left main coronary artery stenosis, its impact on long-term mortality is still unclear.
  
  
  RESULTS
  In the MAIN-COMPARE registry, patients with unprotected left main coronary artery stenosis in a hemodynamically stable condition underwent elective stenting under the guidance of IVUS (756 patients) or conventional angiography (219 patients). Patients with acute myocardial infarction were excluded. The 3-year outcomes between the 2 groups were primarily compared using propensity-score matching in the entire and separate populations according to stent type. In 201 matched pairs of the overall population, there was a tendency of lower risk of 3-year morality with IVUS guidance compared with angiography guidance (6.0% versus 13.6%, log-rank P=0.063; hazard ratio, 0.54; 95% CI, 0.28 to 1.03; Cox-model P=0.061). In particular, in 145 matched pairs of patients receiving drug-eluting stent, the 3-year incidence of mortality was lower with IVUS guidance as compared with angiography guidance (4.7% versus 16.0%, log-rank P=0.048; hazard ratio, 0.39; 95% CI, 0.15 to 1.02; Cox model P=0.055). In contrast, the use of IVUS guidance did not reduce the risk of mortality in 47 matched pairs of patients receiving bare-metal stent (8.6% versus 10.8%, log-rank P=0.35; hazard ratio, 0.59; 95% CI, 0.18 to 1.91; Cox model P=0.38). The risk of myocardial infarction or target vessel revascularization was not associated with the use of IVUS guidance.
  
  
  CONCLUSIONS
  Elective stenting with IVUS guidance, especially in the placement of drug-eluting stent, may reduce the long-term mortality rate for unprotected left main coronary artery stenosis when compared with conventional angiography guidance.
authors.affiliation: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sjpark@amc.seoul.kr
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.forename: Jon
authors.initials: J
authors.lastname: Suh
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000401:mortality; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D008670:Metals