title: Impact of intravascular ultrasound guidance in routine percutaneous coronary intervention for conventional lesions: data from the EXCELLENT trial.
abstract: BACKGROUND
  Intravascular ultrasound (IVUS) offers tomographic images of coronary artery, helping physicians refine percutaneous coronary intervention (PCI) procedures. However, it is still controversial whether routine use of IVUS in conventional lesions leads to improvement in clinical outcomes after PCI.
  
  
  METHODS
  From the EXCELLENT trial, patients were grouped into IVUS-guided versus IVUS-non-guided PCI (619 and 802 patients, respectively). The crude patients as well as the propensity score matched pairs were compared with regard to clinical outcomes.
  
  
  RESULTS
  Baseline characteristics showed younger age and lower incidence of comorbidities in the IVUS group. IVUS-guided PCI was associated with more aggressive treatment such as longer stenting length, larger stent diameter, and greater number of stents implanted. In the total population, IVUS guidance was associated with a significantly higher risk of periprocedural MI with no significant differences in other outcomes. In the matched cohort (463 matched pairs, 926 patients), IVUS guidance was associated with significantly increased risk of target lesion failure (4.3% vs. 2.4%; p=0.047 by conditional logistic regression) and major adverse cardiovascular events at 1 year almost exclusively due to increased risk of periprocedural myocardial infarction (MI) (1.6% vs. 0.2%; p=0.050), while the rates of cardiac death, spontaneous MI, and target lesion revascularization did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  The adjunctive use of IVUS during PCI was associated with more stents implanted, longer stenting, and bigger stenting. There were no significant advantages of IVUS guidance, but rather a significant increase in periprocedural enzyme elevation, reflecting more aggressive procedures performed with IVUS guidance.
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Si-Hyuck
authors.initials: SH
authors.lastname: Kang
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Yang
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Hyun-Jae
authors.initials: HJ
authors.lastname: Kang
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D054855:Drug-Eluting Stents; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D013223:Statistics as Topic / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods