October 4, 2022

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Comparison of DES implantation under the guidance of IVUS and angiography

Comparison of 3-year results of DES implantation under the guidance of IVUS and angiography


Comparison of 3-year results of DES implantation under the guidance of IVUS and angiography.   Intravascular ultrasound (IVUS) has become the recommended treatment for patients with complex coronary artery disease who choose to receive drug-eluting stent (DES) implantation.  Both random and observational studies have confirmed that IVUS guidance is effective for unprotected left main disease, long disease, and Clinical benefits for patients with chronic complete occlusion and complex bifurcation disease.

Previous randomized final trials have confirmed that in all patients undergoing second-generation DES implantation, the IVUS-guided group has a lower 1-year risk of target vessel failure (TVF) compared with the angiography-guided group. In the 2020 TCT conference,

Professor Zhang Junjie from the Chen Shaoliang team of Nanjing First Hospital affiliated to Nanjing Medical University announced the ULTIMATE research results. The study is a prospective, multi-center, randomized controlled study comparing the 3-year clinical difference between IVUS guidance and angiography guidance. Yesterday, “JACC: Cardiovasc Interv” published the entire content, and Yixin compiled the pictures and texts as follows, hoping to help colleagues.

 

Research purposes

The purpose of this study was to investigate the difference in TVF 3 years after implantation of the second-generation drug-eluting stent (DES) under the guidance of intravascular ultrasound (IVUS) and angiography.

 

Methods

A total of 1448 patients who underwent DES implantation from 8 centers in China were enrolled. The patients were randomly assigned to IVUS or angiography for a 3-year follow-up in the final trial.

Primary endpoint: The risk of TVF at 3 years, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target vessel revascularization (TVR).

Safety endpoint: clear or possible stent thrombosis (ST). Unless there is a clear non-cardiac cause, all deaths are considered cardiac deaths.

Standard definition of IVUS compliance:

(1) The minimum lumen area of ​​the stent segment> 5.0 mm2 or> 90% of the lumen area of ​​the distal reference segment;

(2) The plaque load within 5 mm of the stent edge is less than 50%;

(3) There is no edge sandwich that reaches the middle layer and exceeds 3 mm in length.

Only when all three criteria are met simultaneously can the best procedure defined by IVUS be determined. Otherwise, percutaneous coronary intervention (PCI) is defined as suboptimal surgery.

 

Research result

At 3 years, 47 cases (6.6%) in the IVUS guidance group developed TVF, and 76 cases (10.7%) in the angiography guidance group developed TVF (P=0.01). The main reason was that clinically driven target vessel revascularization was reduced (4.5% vs. 4.5%). 6.9%; P=0.05). The diagnosis rate of ST in the IVUS guidance group and angiography guidance group was 0.1% and 1.1%, respectively (P=0.02). It is worth noting that compared with suboptimal surgery, the best surgery defined by IVUS is associated with a significant reduction in TVF at 3 years (Figure 1-4).

Comparison of DES implantation under the guidance of IVUS and angiography
Figure1: A total of 1,448 all comers were randomly assigned to either intravascular ultrasound (IVUS) guidance or angiographic guidance. TVF = target vessel failure.

 

 

Comparison of DES implantation under the guidance of IVUS and angiography
Figure2: (A to D) IVUS guidance was associated with significantly lower rate of TVF and clinically driven target vessel revascularization (TVR) compared with angiographic guidance. There were no statistical differences in cardiac death and target vessel myocardial infarction; (E) IVUS- defined optimal percutaneous coronary intervention was associated with less TVF compared with suboptimal PCI. CI = confidence interval; HR = hazard ratio.

 

 

Comparison of DES implantation under the guidance of IVUS and angiography
Figure3: (A) Landmark analyses for all patients; (B) Landmark analyses for patients in the IVUS guidance group.

 

 

Comparison of DES implantation under the guidance of IVUS and angiography
Figure4: 3-Year Follow-Up of the IVUS-Guided Drug-Eluting Stents Implantation in All-Comers Coronary Lesions Trial.

 

 

Conclusion

Compared with those who received angiographic guidance, IVUS-guided DES implantation was associated with a significant reduction in the incidence of TVF and ST during the 3-year follow-up period for all patients, especially those who received the best surgery defined by IVUS.

 

 

 

(source:internet, reference only)


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