title: Clinical impact of intravascular ultrasound guidance in drug-eluting stent implantation for unprotected left main coronary disease: pooled analysis at the patient-level of 4 registries.
abstract: OBJECTIVE
  This study sought to investigate the clinical impact of the use of intravascular ultrasound (IVUS) during revascularization of patients with left main coronary artery (LM) disease with drug-eluting stents (DES).
  
  
  BACKGROUND
  Whether the use of IVUS during the procedure adds a clinical benefit remains unclear. There is only 1 previous observational study, with relevant limitations, supporting the value of this strategy.
  
  
  METHODS
  We performed a patient-level pooled analysis of 4 registries of patients with LM disease treated with DES in Spain. A propensity score-matching method was used to obtain matched pairs of patients with and without IVUS guidance.
  
  
  RESULTS
  A total of 1,670 patients were included, and 505 patients (30.2%) underwent DES implantation under IVUS guidance (IVUS group). By means of the matching method, 505 patients without the use of IVUS during revascularization were selected (no-IVUS group). Survival free of cardiac death, myocardial infarction, and target lesion revascularization at 3 years was 88.7% in the IVUS group and 83.6% in the no-IVUS group (p = 0.04) for the overall population, and 90% and 80.7%, respectively (p = 0.03), for the subgroups with distal LM lesions. The incidence of definite and probable thrombosis was significantly lower in the IVUS group (0.6% vs. 2.2%; p = 0.04). Finally, IVUS-guided revascularization was identified as an independent predictor for major adverse events in the overall population (hazard ratio: 0.70, 95% confidence interval: 0.52 to 0.99; p = 0.04) and in the subgroup with distal lesions (hazard ratio: 0.54, 95% confidence interval: 0.34 to 0.90; p = 0.02).
  
  
  CONCLUSIONS
  The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES.
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Marques de Valdecilla, Santander, Spain. Electronic address: he1thj@humv.es.
authors.forename: Jose M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Meixoeiro, Vigo, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Baz Alonso
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Gómez Hospital
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso Manterola
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Marques de Valdecilla, Santander, Spain.
authors.forename: Tamara
authors.initials: T
authors.lastname: Garcia Camarero
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Valladolid, Valladolid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Gimeno de Carlos
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura Ferrer
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital La Paz, Madrid, Spain.
authors.forename: Angel Sanchez
authors.initials: AS
authors.lastname: Recalde
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Iñigo Lozano
authors.initials: IL
authors.lastname: Martínez-Luengas
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez Lara
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernandez Hernandez
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Pérez-Vizcayno
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier Fillat
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Leon, Leon, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: Perez de Prado
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Agustín Albarrán
authors.initials: AA
authors.lastname: Gonzalez-Trevilla
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Victoria, Malaga, Spain.
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Jimenez Navarro
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Josepa
authors.initials: J
authors.lastname: Mauri Ferre
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Fernandez Diaz
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pinar Bermudez
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Marques de Valdecilla, Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Zueco Gil
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D012042:Registries; D013030:Spain / Q000453:epidemiology; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D018084:Ultrasonography, Interventional
keywords: drug-eluting stent(s); intravascular ultrasound; left main coronary artery