title: Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial.
abstract: OBJECTIVE
  Use of intravascular ultrasound (IVUS) promotes better clinical outcomes for coronary intervention in complex coronary lesions. However, randomized data demonstrating the clinical usefulness of IVUS are limited for lesions treated with drug-eluting stents.
  
  
  OBJECTIVE
  To determine whether the long-term clinical outcomes with IVUS-guided drug-eluting stent implantation are superior to those with angiography-guided implantation in patients with long coronary lesions.
  
  
  METHODS
  The Impact of Intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions (IVUS-XPL) randomized, multicenter trial was conducted in 1400 patients with long coronary lesions (implanted stent ≥28 mm in length) between October 2010 and July 2014 at 20 centers in Korea.
  
  
  METHODS
  Patients were randomly assigned to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation.
  
  
  METHODS
  Primary outcome measure was the composite of major adverse cardiac events, including cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 1 year, analyzed by intention-to-treat.
  
  
  RESULTS
  One-year follow-up was complete in 1323 patients (94.5%). Major adverse cardiac events at 1 year occurred in 19 patients (2.9%) undergoing IVUS-guided and in 39 patients (5.8%) undergoing angiography-guided stent implantation (absolute difference, -2.97% [95% CI, -5.14% to -0.79%]) (hazard ratio [HR], 0.48 [95% CI, 0.28 to 0.83], P = .007). The difference was driven by a lower risk of ischemia-driven target lesion revascularization in patients undergoing IVUS-guided (17 [2.5%]) compared with angiography-guided (33 [5.0%]) stent implantation (HR, 0.51 [95% CI, 0.28 to 0.91], P = .02). Cardiac death and target lesion-related myocardial infarction were not significantly different between the 2 groups. For cardiac death, there were 3 patients (0.4%) in the IVUS-guided group and 5 patients (0.7%) in the angiography-guided group (HR, 0.60 [95% CI, 0.14 to 2.52], P = .48). Target lesion-related myocardial infarction occurred in 1 patient (0.1%) in the angiography-guided stent implantation group (P = .32).
  
  
  CONCLUSIONS
  Among patients requiring long coronary stent implantation, the use of IVUS-guided everolimus-eluting stent implantation, compared with angiography-guided stent implantation, resulted in a significantly lower rate of the composite of major adverse cardiac events at 1 year. These differences were primarily due to lower risk of target lesion revascularization.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01308281.
authors.affiliation: Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, Korea2Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung-Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Preventive Medicine and Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chung-Mo
authors.initials: CM
authors.lastname: Nam
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.affiliation: Dankook University College of Medicine, Cheonan, Korea.
authors.forename: Tae-Soo
authors.initials: TS
authors.lastname: Kang
authors.affiliation: Gil Hospital, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Woong-Chol
authors.initials: WC
authors.lastname: Kang
authors.affiliation: School of Medicine, Kangwon National University, Chuncheon, Korea.
authors.forename: Ae-Young
authors.initials: AY
authors.lastname: Her
authors.affiliation: School of Medicine, Kangwon National University, Chuncheon, Korea.
authors.forename: Yong Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: School of Medicine, Kangwon National University, Chuncheon, Korea.
authors.forename: Yonghoon
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Keimyung University College of Medicine, Daegu, Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.affiliation: Kangnam Severance Hospital, Seoul, Korea.
authors.forename: Bum-Kee
authors.initials: BK
authors.lastname: Hong
authors.affiliation: Kangnam Severance Hospital, Seoul, Korea.
authors.forename: Hyuckmoon
authors.initials: H
authors.lastname: Kwon
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea9Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea10Cardiovascular Research Institute, Yonsei Universit.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea9Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea10Cardiovascular Research Institute, Yonsei Universit.
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D054855:Drug-Eluting Stents / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019919:Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015641:Radiography, Interventional / Q000009:adverse effects / Q000401:mortality; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000401:mortality
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus