title: A randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID Trial).
abstract: BACKGROUND
  AVID (Angiography Versus Intravascular ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of intravascular ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR).
  
  
  RESULTS
  After elective coronary stent placement and an optimal angiographic result (<10% stenosis), 800 patients were randomized to Angiography- or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90+/-2.43 mm(2) in the Angiography group and 7.55+/-2.82 mm(2) in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level [CI], [-8.3% to 0.5%]). When vessels with a distal reference diameter <2.5 mm by core laboratory angiography measurement were excluded from analysis, the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the IVUS group (P=0.01, 95% CI, [-10.6% to -1.2%]). With a pre-stent angiographic stenosis of > or =70%, the TLR rate was lower in the IVUS group compared with the Angiography group (3.1% versus 14.2%; P=0.002; 95% CI, [-18.4% to -4.2%]).
  
  
  CONCLUSIONS
  IVUS-directed bare-metal stent placement results in larger acute stent dimensions without an increase in complications and a significantly lower 12-month TLR rate for vessels > or =2.5 mm by angiography and for vessels with high-grade pre-stent stenosis. However, for the entire sample analyzed on an intention-to-treat basis, IVUS-directed bare-metal stent placement does not significantly reduce the 12-month TLR rate when compared with stent placement guided by angiography alone. In addition, IVUS evaluation of adequate stent expansion is underutilized by experienced operators.
authors.affiliation: Division of Cardiovascular Diseases, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA. Russo.Robert@ScrippsHealth.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Russo
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Silva
authors.forename: Paul S
authors.initials: PS
authors.lastname: Teirstein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Attubato
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
authors.forename: Anthony C
authors.initials: AC
authors.lastname: DeFranco
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.forename: Steven L
authors.initials: SL
authors.lastname: Goldberg
authors.forename: James B
authors.initials: JB
authors.lastname: Hermiller
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Ling
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Lucisano
authors.forename: Richard A
authors.initials: RA
authors.lastname: Schatz
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: David M
authors.initials: DM
authors.lastname: Zientek
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States
chemical_list: D008670:Metals