title: Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study.
abstract: BACKGROUND
  Prior small to modest-sized studies suggest a benefit of intravascular ultrasound (IVUS) guidance in noncomplex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown.
  
  
  RESULTS
  Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter, nonrandomized "all-comers" study of 8583 consecutive patients at 11 international centers designed to determine the frequency, timing, and correlates of stent thrombosis and adverse clinical events after DES. Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes. IVUS was utilized in 3349 patients (39%), and larger-diameter devices, longer stents, and/or higher inflation pressures were used in 74% of IVUS-guided cases. IVUS guidance compared with angiography guidance was associated with reduced 1-year rates of definite/probable stent thrombosis (0.6% [18 events] versus 1.0% [53 events]; adjusted hazard radio, 0.40; 95% confidence interval, 0.21-0.73; P=0.003), myocardial infarction (2.5% versus 3.7%; adjusted hazard radio, 0.66; 95% confidence interval, 0.49-0.88; P=0.004), and composite adjudicated major adverse cardiac events (ie, cardiac death, myocardial infarction, or stent thrombosis) (3.1% versus 4.7%; adjusted hazard radio, 0.70; 95% confidence interval, 0.55-0.88; P=0.002). The benefits of IVUS were especially evident in patients with acute coronary syndromes and complex lesions, although significant reductions in major adverse cardiac events were present in all patient subgroups those with including stable angina and single-vessel disease.
  
  
  CONCLUSIONS
  In ADAPT-DES, the largest study of IVUS use to date, IVUS guidance was associated with a reduction in stent thrombosis, myocardial infarction, and major adverse cardiac events within 1 year after DES implantation.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
authors.affiliation: From Amper Kliniken AG, Dachau, Germany (B.W.); NewYork-Presbyterian/Columbia University Medical Center, New York, NY (A.M., G.W., G.W.S.); Cardiovascular Research Foundation, New York, NY (A.M., G.W., K.X., H.P., R.M., G.S.M., G.W.S.); Universitäts-Herzzentrum Freibrug Bad Krozingen, Bad Krozingen, Germany (F.N.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); LeBauer Cardiovascular Research Foundation/Moses Cone Hospital, Greensboro, NC (B.R.B., T.D.S.); The Ohio State University, Columbus, OH (E.L.M.); and Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rinaldi
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Peter L
authors.initials: PL
authors.lastname: Duffy
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Mazzaferri
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: imaging; stent; thrombosis