- 作者：Jose M. de la Torre Hernandez ; MD ; PhD&lowast ; ; he1thj@humv.es" class="auth_mail ; José ; A. Baz Alonso ; MD&dagger ; ; Joan A. Gó ; mez Hospital ; MD ; PhD&Dagger ; ; Fernando Alfonso Manterola ; MD ; PhD§ ; ; Tamara Garcia Camarero ; MD&lowast ; ; Federico Gimeno de Carlos ; MD ; PhD鈥?/sup> ; Gerard Roura Ferrer ; MD&Dagger ; ; Angel Sanchez Recalde ; MD¶ ; ; Í ; ñ ; igo Lozano Martí ; nez-Luengas ; MD ; PhD# ; Josep Gomez Lara ; MD&Dagger ; ; Felipe Hernandez Hernandez ; MD&lowast ; &lowast ; ; Marí ; a J. Pé ; rez-Vizcayno ; MD§ ; ; Angel Cequier Fillat ; MD ; PhD&Dagger ; ; Armando Perez de Prado ; MD&dagger ; &dagger ; ; Agustí ; n Albarrá ; n Gonzalez-Trevilla ; MD&lowast ; &lowast ; ; Manuel F. Jimenez Navarro ; MD ; PhD&Dagger ; &Dagger ; ; Josepa Mauri Ferre ; MD§ ; § ; ; Jose A. Fernandez Diaz ; MD鈥栤€?/sup> ; Eduardo Pinar Bermudez ; MD ; PhD¶ ; ¶ ; ; Javier Zueco Gil ; MD&lowast ; ; on behalf of the collaborative IVUS-TRONCO-ICP Spanish study
- 关键词：drug-eluting stent(s) ; intravascular ultrasound ; left main coronary artery
- 刊名：JACC: Cardiovascular Interventions
- 出版年：March, 2014
- 年：2014
- 卷：7
- 期：3
- 页码：244-254
- 全文大小：1649 K
Objectives
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聽= 0.04) for the overall population, and 90% and 80.7%, respectively (p聽= 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聽= 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聽= 0.04) and in the subgroup with distal lesions (hazard ratio: 0.54, 95% confidence interval: 0.34 to 0.90; p聽= 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.