title: Impact of intravascular ultrasound on the long-term clinical outcomes in the treatment of coronary ostial lesions.
abstract: OBJECTIVE
  To evaluate the long-term outcomes of patients with ostial lesions who underwent percutaneous coronary intervention (PCI) with and without the use of intravascular ultrasound (IVUS).
  
  
  BACKGROUND
  A higher rate of adverse cardiac events is associated with PCI of ostial lesions as compared with nonostial disease.
  
  
  METHODS
  From 7/2002 to 8/2010, 225 patients with 233 coronary ostial lesions underwent PCI with (n = 82) and without (n = 143) IVUS guidance. Ostial lesions included both native aorto-ostial or major coronary vessel (left anterior descending, left circumflex, and ramus intermedius) lesions. Clinical outcomes [cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR)] at a mean follow-up of 4.2 ± 2.5 years were compared between patients undergoing PCI of an ostial lesion with and without use of IVUS using univariate and propensity score adjusted analyses.
  
  
  RESULTS
  Aorto-ostial lesions (n = 109) comprised 47% of lesions, whereas the remaining lesions (53%) involved major coronary vessels. After propensity score adjustment, IVUS use was associated with lower rates of the composite of cardiovascular death, MI, or TLR (HR 0.54, 95% CI 0.29-0.99; P = 0.04), composite MI or TLR (HR 0.39, 95% CI 0.18-0.83; P = 0.01), and MI (HR 0.31, 95% CI 0.11-0.85; P = 0.02) as compared with no IVUS. The use of IVUS was also associated with a trend towards a lower rate of TLR (HR 0.42, 95% CI 0.17-1.02; P = 0.06).
  
  
  CONCLUSIONS
  PCI of coronary ostial lesions with the use of IVUS was associated with significantly lower rates of adverse cardiac events.
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jeremiah P
authors.initials: JP
authors.lastname: Depta
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jayendrakumar S
authors.initials: JS
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Shriti K
authors.initials: SK
authors.lastname: Masrani
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Howard I
authors.initials: HI
authors.lastname: Kurz
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: coronary ostial; intravascular ultrasound; percutaneous coronary intervention