title: Intravascular ultrasound-guided percutaneous coronary intervention improves the clinical outcome in patients undergoing multiple overlapping drug-eluting stents implantation.
abstract: OBJECTIVE
  Stented segment length is a predictive factor for restenosis and stent thrombosis still in the drug-eluting stent (DES) era, and the benefit of routine intravascular ultrasound (IVUS) is still unclear. The aim of the present study was to investigate whether IVUS-guided percutaneous coronary intervention (PCI) improved the vascular outcomes as compared with conventional PCI in the treatment of diffuse coronary artery disease.
  
  
  METHODS
  From our registry database from January 2006 to May 2009, we identified 85 consecutive patients with de novo coronary lesions treated with at least 64 mm of multiple, overlapping DES. The 2-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fatal myocardial infarction, target lesion revascularization (TLR), or stent thrombosis, was compared according to the use of IVUS.
  
  
  RESULTS
  The 2-year MACE rate was lower in the IVUS-guided group than that of the angiography-guided group (8% vs. 33.3%, p=0.005). The incidence of TLR was lower in patients with IVUS use than in those without IVUS use (0% vs. 27.8%, p<0.001). On Cox proportional hazard analysis, no IVUS use {hazard ratio (HR) 5.917, 95% confidence interval (CI) 1.037-33.770, p=0.045} and age (HR 1.097, 95% CI 1.006-1.138, p=0.032) were unfavorable predictors for the 2-year MACE.
  
  
  CONCLUSIONS
  The use of IVUS may improve the effectiveness and safety of multiple overlapping drug-eluting stenting for long, diffuse coronary lesions.
authors.affiliation: Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Sung Gyun
authors.initials: SG
authors.lastname: Ahn
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Joong Kyung
authors.initials: JK
authors.lastname: Sung
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Youn
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Ahn
authors.forename: Jang-Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Byung-Su
authors.initials: BS
authors.lastname: Yoo
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Kyung-Hoon
authors.initials: KH
authors.lastname: Choe
keywords: Coronary stenosis; Drug-eluting stents; Intravascular ultrasonography; Percutaneous coronary intervention; Thrombosis