title: Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: data from a Korean multicenter bifurcation registry.
abstract: BACKGROUND
  although intravascular ultrasound (IVUS) has been widely used for complex lesions during coronary intervention, IVUS for stenting at bifurcation lesions has not been sufficiently assessed. The aim of this study was to investigate the impact of IVUS guidance on long-term clinical outcomes during drug-eluting stent (DES) implantation for bifurcation lesions.
  
  
  METHODS
  the Korean multicenter bifurcation registry listed 1,668 patients with non-left main de novo bifurcation lesions who underwent DES implantation between January 2004 and June 2006. Using propensity score matching with clinical and angiographic characteristics, 487 patients with IVUS guidance and 487 patients with angiography guidance were selected. The long-term clinical outcomes were compared between the 2 groups.
  
  
  RESULTS
  baseline clinical and angiographic characteristics were well matched and showed no significant differences between the 2 groups. Two-stent technique and final kissing ballooning angioplasty were more frequently performed in the IVUS-guided group. Maximal stent diameters at both the main vessel and the side branch were larger in the IVUS-guided group. Periprocedural creatine kinase-MB elevation (>3 times of upper normal limits) was frequently observed in the angiography-guided group. The incidence of death or myocardial infarction was significantly lower in the IVUS-guided group compared to the angiography-guided group (3.8% vs 7.8%, log rank test P = .03, hazard ratio 0.44, 95% CI 0.12-0.96, Cox model P = .04).
  
  
  CONCLUSIONS
  intravascular ultrasound guidance during DES implantation at bifurcation lesions may be helpful to improve long-term clinical outcomes by reducing the occurrence of death or myocardial infarction.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Yang
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
mesh_terms: D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*