Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry
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- 作者：Giuseppe Biondi-Zoccai (1)
Imad Sheiban (2)
Enrico Romagnoli (3)
Stefano De Servi (5)
Corrado Tamburino (6)
Antonio Colombo (4)
Francesco Burzotta (7)
Patrizia Presbitero (8)
Leonardo Bolognese (9)
Leonardo Paloscia (10)
Paolo Rubino (11)
Gennaro Sardella (12)
Carlo Briguori (13)
Luigi Niccoli (14)
Gianfranco Franco (15)
Domenico Di Girolamo (16)
Luigi Piatti (17)
Cesare Greco (18)
Davide Capodanno (6)
Giuseppe Sangiorgi (19) - 关键词：Bifurcation ; Coronary artery disease ; Intravascular ultrasound ; Percutaneous transluminal coronary angioplasty ; Stent
- 刊名：Clinical Research in Cardiology
- 出版年：2011
- 出版时间：November 2011
- 年：2011
- 卷：100
- 期：11
- 页码：1021-1028
- 全文大小：1620KB
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Imad Sheiban (2)
Enrico Romagnoli (3)
Stefano De Servi (5)
Corrado Tamburino (6)
Antonio Colombo (4)
Francesco Burzotta (7)
Patrizia Presbitero (8)
Leonardo Bolognese (9)
Leonardo Paloscia (10)
Paolo Rubino (11)
Gennaro Sardella (12)
Carlo Briguori (13)
Luigi Niccoli (14)
Gianfranco Franco (15)
Domenico Di Girolamo (16)
Luigi Piatti (17)
Cesare Greco (18)
Davide Capodanno (6)
Giuseppe Sangiorgi (19)
1. Division of Cardiology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
2. Division of Cardiology, University of Turin, Turin, Italy
3. Division of Cardiology, Policlinico Casilino, Rome, Italy
5. Dipartimento Cardiovascolare, Ospedale di Legnano, Milan, Italy
6. Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
4. Interventional Cardiology, San Raffaele Institute, and EMO-GVM Centro Cuore Columbus, Milan, Italy
7. Institute of Cardiology, Catholic University, Rome, Italy
8. Division of Cardiology, Istituto Clinico Humanitas, Rozzano, Milan, Italy
9. Cardiovascular Department, San Donato Hospital, Arezzo, Italy
10. Interventional Cardiology, Santo Spirito Hospital, Pescara, Italy
11. Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy
12. Cardiovascular Sciences, Policlinico Umberto I, Rome, Italy
13. Division of Cardiology, Clinica Mediterranea, Naples, Italy
14. Interventional Cardiology, Spedali Civili, Brescia, Italy
15. Interventional Cardiology, Mater Salutis Hospital, Legnago, Italy
16. Interventional Cardiology, San Sebastiano Hospital, Caserta, Italy
17. Interventional Cardiology, Manzoni Hospital, Lecco, Italy
18. Second Division of Cardiology, Department of Heart and Great Vessels ‘Attilio Reale- University of Rome, Rome, Italy
19. Division of Cardiology, University of Tor Vergata, Rome, Italy
文摘
Background Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. Methods A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. Results A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p?>?0.05). After 24?±?15?months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p?>?0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p?>?0.05). Conclusions Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.