title: Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions.
abstract: Percutaneous coronary intervention (PCI) of bifurcation lesions remains challenging with a higher risk of adverse outcomes. Whether adjunctive intravascular ultrasound (IVUS) imaging improves outcomes of PCI of bifurcation lesions remains unclear. This study sought to determine the long-term clinical outcomes associated with using IVUS for percutaneous treatment of coronary bifurcation lesions. From April 2003 through August 2010, 449 patients with 471 bifurcation lesions underwent PCI with (n = 247) and without (n = 202) the use of IVUS. Clinical outcomes (death, myocardial infarction [MI], periprocedural MI, stent thrombosis, target vessel revascularization [TVR], and target lesion revascularization [TLR]) were compared between patients undergoing PCI with and without IVUS using univariate and propensity score-adjusted analyses. Most patients (61%) presented with acute coronary syndrome and 89% of bifurcations lesions were Medina class 1,1,1. After propensity score adjustment, use of IVUS was associated with significantly lower rates of death or MI (odds ratio 0.38, 95% confidence interval 0.20 to 0.74, p = 0.005), death (odds ratio 0.40, 95% confidence interval 0.18 to 0.88, p = 0.02), MI (odds ratio 0.37, 95% confidence interval 0.14 to 0.98, p = 0.04), periprocedural MI (odds ratio 0.45, 95% confidence interval 0.20 to 0.97, p = 0.04), TVR (odds ratio 0.28, 95% confidence interval 0.14 to 0.53, p <0.0001), and TLR (odds ratio 0.27, 95% confidence interval 0.14 to 0.53, p = 0.0003) compared to no IVUS. In conclusion, IVUS-guided treatment of complex bifurcation lesions was associated with significantly lower rates of adverse cardiac events at late follow-up. Further study is warranted to evaluate the role of IVUS guidance in improving long-term outcomes after PCI of bifurcation lesions.
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Patel
authors.forename: Jeremiah P
authors.initials: JP
authors.lastname: Depta
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.forename: Michael
authors.initials: M
authors.lastname: Yeung
authors.forename: Kory
authors.initials: K
authors.lastname: Lavine
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Banerjee
authors.forename: C Huie
authors.initials: CH
authors.lastname: Lin
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.forename: Howard I
authors.initials: HI
authors.lastname: Kurz
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
mesh_terms: D000368:Aged; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional