Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions.
Stenting for bifurcation lesions is still challenging, and the effect of intravascular ultrasound (IVUS) guidance on long-term outcomes has not been evaluated. We assessed the long-term outcomes of IVUS-guided stenting in bifurcation lesions. We evaluated 758 patients with de novo nonleft main coronary bifurcation lesions who underwent stent implantation from January 1998 to February 2006. We compared the adverse outcomes (i.e., death, stent thrombosis, and target lesion revascularization) within 4 years, after adjustment using a multivariate Cox proportional hazard model and propensity scoring. IVUS-guided stenting significantly reduced the long-term all-cause mortality (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.13 to 0.74, p = 0.008) in the total population and in the patients receiving drug-eluting stents (DESs) (HR 0.24, 95% CI 0.06 to 0.86, p = 0.03), but not in the patients receiving bare metal stents (HR 0.41, 95% CI 0.13 to 1.26, p = 0.12). IVUS-guided stenting had no effect on the rate of stent thrombosis (HR 0.48, 95% CI 0.16 to 1.43, p = 0.19) or target lesion revascularization (HR 1.47, 95% CI 0.79 to 2.71, p = 0.21). In patients receiving DESs, however, IVUS guidance reduced the development of very late stent thrombosis (0.4% vs 2.8%, p = 0.03, log-rank test). In conclusion, in patients receiving DESs, IVUS-guided stenting for treatment of bifurcation lesions significantly reduced the 4-year mortality compared to conventional angiographically guided stenting. In addition, IVUS guidance reduced the development of very late stent thrombosis in patients receiving DESs.
Kim
Sung-Hwan
SH
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kim
Young-Hak
YH
Kang
Soo-Jin
SJ
Park
Duk-Woo
DW
Lee
Seung-Whan
SW
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Cheong
Sang-Sig
SS
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional