Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures
Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures
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DOI：
10.1016/j.jcin.2019.01.227
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发表时间：
2019-04-08
影响因子：
11.3
通讯作者：
Hahn, Joo-Yong
中科院分区：
文献类型：
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作者：
Choi, Ki Hong;Song, Young Bin;Hahn, Joo-Yong
目的：本研究旨在确定与血管造影指导相比，血管内超声（IVUS）指导是否能降低接受复杂经皮冠状动脉介入治疗（PCI）的患者心脏死亡的长期风险。虽然IVUS是准确评估病变概况和最佳支架植入的有用工具，但对于复杂病变患者，IVUS引导和血管造影引导的PCI之间的长期临床结果数据有限。方法：从2003年3月至2015年12月，从前瞻性机构登记中共纳入6005例接受PCI治疗复杂病变的药物洗脱支架患者。所有纳入的受试者至少有1个复杂病变（定义为分叉、慢性全闭塞、左主干疾病、长病变、多支PCI、多次支架植入、支架内再狭窄或严重钙化病变）。根据是否使用IVUS对患者进行分类。采用多重敏感性分析，包括多变量调整、倾向评分匹配和反概率加权法来调整基线差异。结果在研究人群中，有1674例患者（27.9%）在复杂PCI中使用IVUS。与血管造影引导下的PCI组相比，ivus引导下的PCI组平均支架直径更大（3.2 +/- 0.4 vs. 3.0 +/- 0.4, p < 0.001），扩张后使用频率更高（49.0% vs. 17.9%, p < 0.001）。在64个月的中位随访期间，ivus引导下的PCI与血管造影引导下的PCI相比，心脏死亡风险显著降低（10.2% vs. 16.9%；风险比：0.573；95%可信区间：0.460 ~ 0.714;p < 0.001）。采用多变量回归、倾向评分匹配、反概率加权等方法，结果一致。ivus引导下PCI组全因死亡、心肌梗死、支架血栓形成、缺血驱动靶病变血运重建术和主要心脏不良事件的风险也显著降低。结论：在复杂冠状动脉病变患者中，ivus引导下的PCI与血管造影引导下的PCI相比，心脏死亡和心脏不良事件的长期风险较低。对于复杂的PCI，应积极考虑使用IVUS。(C) 2019年由美国心脏病学会基金会发布。
OBJECTIVES This study sought to determine whether intravascular ultrasound (IVUS) guidance compared with angiographic guidance reduces long-term risk of cardiac death in patients undergoing complex percutaneous coronary intervention (PCI).BACKGROUND Although IVUS is a useful tool for accurate assessment of lesion profiles and optimal stent implantation, there are limited data on long-term clinical outcomes between IVUS-guided and angiography-guided PCI for patients with complex lesions.METHODS From March 2003 through December 2015, a total of 6,005 patients undergoing PCI for complex lesions with drug-eluting stents were enrolled from a prospective institutional registry. All enrolled subjects had at least 1 complex lesion (defined as bifurcation, chronic total occlusion, left main disease, long lesion, multivessel PCI, multiple stent implantation, in-stent restenosis, or heavily calcified lesion). Patients were classified according to use of IVUS or not. Multiple sensitivity analyses, including multivariable adjustment, propensity-score matching, and inverse-probability-weighted method, were performed to adjust baseline differences.RESULTS Among the study population, IVUS was used in 1,674 patients (27.9%) during complex PCI. The IVUS-guided PCI group had a significantly larger mean stent diameter (3.2 +/- 0.4 vs. 3.0 +/- 0.4; p < 0.001), and more frequent use of post-dilatation (49.0% vs. 17.9%; p < 0.001) compared with the angiography-guided PCI group. IVUS-guided PCI was associated with a significantly lower risk of cardiac death during 64 months of median follow-up compared with angiography-guided PCI (10.2% vs. 16.9%; hazard ratio: 0.573; 95% confidence interval: 0.460 to 0.714; p < 0.001). Results were consistent after multivariable regression, propensity-score matching, and inverse-probability-weighted method. The risks of all-cause death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, and major adverse cardiac events were also significantly lower in the IVUS-guided PCI group.CONCLUSIONS Among patients with complex coronary artery lesion, IVUS-guided PCI was associated with the lower long-term risk of cardiac death and adverse cardiac events compared with angiography-guided PCI. Use of IVUS should be actively considered for complex PCI. (C) 2019 by the American College of Cardiology Foundation.