Utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention for type C lesions.
BACKGROUND
Percutaneous coronary intervention (PCI) of complex lesions (i.e., American College of Cardiology/American Heart Association class type C) remains challenging and the outcome may be compromised. The use of intravascular ultrasound (IVUS) to guide PCI was suggested to improve outcome.


METHODS
A cohort of 1,984 patients who underwent PCI to type C lesions in our center from April 2000 to March 2010 was identified. Using propensity score matching with clinical and angiographic characteristics, we identified 637 patients who underwent IVUS guidance and 637 patients who had only angiographic guidance PCI. Major adverse cardiovascular events (MACE), a composite end-point of all-cause mortality, Q-wave myocardial infarction and target lesion revascularization, were compared between the 2 groups.


RESULTS
After propensity score matching, baseline clinical and angiographic characteristics were well matched. Patients undergoing IVUS-guided PCI had less predilatation and more postdilatation, and were treated more often with cutting balloon. Final diameter stenosis was significantly smaller in the IVUS-guided group (3 ± 11% vs. 7 ± 19%, P < 0.001), resulting in higher angiographic success compared with the non-IVUS-guided group (97.9% vs. 94.8%, P < 0.001). The incidence of MACE was significantly lower in the IVUS-guided group compared to the angiography-guided group (11.0% vs. 15.6%, P = 0.017) as was cardiac death (1.9% vs. 4.4%, P = 0.010).


CONCLUSIONS
IVUS-guided PCI for complex type C lesions is associated with better outcome and should be considered for these lesions.
Department of Cardiology, Washington Hospital Center, Washington, District of Columbia 20010, USA.
Kohei
K
Wakabayashi
Joseph
J
Lindsay
Ana
A
Laynez-Carnicero
Itsik
I
Ben-Dor
Gabriel
G
Sardi
Rebecca
R
Torguson
Zhenyi
Z
Xue
Lowell F
LF
Satler
Augusto D
AD
Pichard
Ron
R
Waksman
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D004219:District of Columbia; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D018084:Ultrasonography, Interventional