title: Impact of intravascular ultrasound imaging on early and late clinical outcomes following percutaneous coronary intervention with drug-eluting stents.
abstract: OBJECTIVE
  This study sought to assess the impact of intravascular ultrasound (IVUS)-guided versus angiography-guided drug-eluting stent (DES) implantation.
  
  
  BACKGROUND
  There are limited data on IVUS guidance in the DES era. Therefore, we investigated the impact of IVUS guidance on clinical outcomes in the MATRIX (Comprehensive Assessment of Sirolimus-Eluting Stents in Complex Lesions) registry.
  
  
  METHODS
  The MATRIX registry prospectively enrolled consecutive, unselected patients treated with sirolimus-eluting stents (SES) (n = 1,504); 631 patients (42%) underwent IVUS-guided stenting, and 873 (58%) had only angiographic guidance. We assessed 30-day, 1-year, and 2-year rates of death/myocardial infarction (MI), major adverse cardiac events (cardiac death, MI, or target vessel revascularization), and definite/probable stent thrombosis in 548 propensity-score matched patient pairs.
  
  
  RESULTS
  After matching, baseline and angiographic characteristics were similar in IVUS and no-IVUS groups. Patients in the IVUS group had significantly less death/MI at 30 days (1.5% vs. 4.6%, p < 0.01), 1 year (3.3% vs. 6.5%, p < 0.01), and 2 years (5.0% vs. 8.8%, p < 0.01). Patients in the IVUS group had significantly less major adverse cardiac events at 30 days (2.2% vs. 4.8%, p = 0.04) and numerically less major adverse cardiac events at 1 year (9.1% vs. 13.5%, p = 0.07) and 2 years (12.9% vs. 16.7%, p = 0.18). Rates of MI were significantly lower in the IVUS group at 30 days (1.5% vs. 4.0%, p < 0.01), 1 year (1.8% vs. 4.8%, p < 0.01), and 2 years (2.1% vs. 5.7%, p < 0.01).
  
  
  CONCLUSIONS
  IVUS-guided stent implantation appears to be associated with a reduction in both early and long-term clinical events. Further investigation in randomized controlled trials is warranted.
authors.affiliation: Cardiovascular Research Foundation, Clinical Trial Center, New York, New York, USA.
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Ozgen
authors.initials: O
authors.lastname: Dogan
authors.forename: José
authors.initials: J
authors.lastname: de Ribamar Costa
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Irene
authors.initials: I
authors.lastname: Apostolidou
authors.forename: Andy
authors.initials: A
authors.lastname: Morales
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Chantziara
authors.forename: George
authors.initials: G
authors.lastname: Syros
authors.forename: Elias
authors.initials: E
authors.lastname: Sanidas
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009519:New York City; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000379:methods*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D020123:Sirolimus