Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly.
OBJECTIVE
To investigate whether intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) could improve clinical outcomes compared with angiography-guided PCI in the treatment of unprotected left main coronary artery stenosis (ULMCA) in the elderly.


METHODS
This controlled study was carried out between October 2009 and September 2012, in Qinhuangdao First Hospital, Hebei Province, China. One hundred and twenty-three consecutive patients with ULMCA, aged 70 or older, were randomized to an IVUS-guided group and a control group. The occurrence of major adverse cardiac events (MACE): death, non-fatal myocardial infarction, or target lesion revascularizations) were recorded after 2 years of follow-up.


RESULTS
The IVUS-guided group had a lower rate of 2-year MACE than the control group (13.1% versus 29.3%, p=0.031). The incidence of target lesion revascularization was lower in the IVUS-guided group than in the control group (9.1% versus 24%, p=0.045). However, there were no differences in death and myocardial infarction in the 2 groups. On Cox proportional hazard analysis, distal lesion was the independent predictor of MACE (hazard ratio [HR]: 1.99, confidence interval [CI]: 1.129-2.367; p=0.043); IVUS guidance was independent factor of survival free of MACE (HR: 0.414, CI: 0.129-0.867; p=0.033).


CONCLUSIONS
The use of IVUS could reduce MACE in elderly patients undergoing ULMCA intervention.
Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, No. 258 Wenhua Road, Qinhuangdao, Hebei Province 066000, China. E-mail. qhdtanqiang@aliyun.com.
Qiang
Q
Tan
Qingsheng
Q
Wang
Dongtian
D
Liu
Shuangyue
S
Zhang
Yang
Y
Zhang
Yang
Y
Li
D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional