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Intravascular Ultrasound Guidance is Associated with Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared with Angiography Guidance Alone

Andell, Pontus LU ; Karlsson, Sofia LU ; Mohammad, Moman A. LU ; Götberg, Matthias LU ; James, Stefan; Jensen, Jens; Fröbert, Ole; Angeras, Oskar; Nilsson, Johan and Omerovic, Elmir, et al. (2017) In Circulation: Cardiovascular Interventions 10(5).
Abstract

Background - Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study. Methods and Results - Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Of 2468 patients, IVUS guidance was used in 621... (More)

Background - Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study. Methods and Results - Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Of 2468 patients, IVUS guidance was used in 621 (25.2%). The IVUS group was younger (median age, 70 versus 75 years) and had fewer comorbidities but more complex lesions. IVUS was associated with larger stent diameters (median, 4 mm versus 3.5 mm). After adjusting for potential confounders, IVUS was associated with significantly lower occurrence of the primary composite end point of all-cause mortality, restenosis, or definite stent thrombosis (hazard ratio, 0.65; 95% confidence interval, 0.50-0.84) and all-cause mortality alone (hazard ratio, 0.62; 95% confidence interval, 0.47-0.82). In 340 propensity score-matched pairs, IVUS was also associated with significantly lower occurrence of the primary end point (hazard ratio, 0.54; 95% confidence interval, 0.37-0.80). Conclusions - IVUS was associated with an independent and significant outcome benefit when performing unprotected LMCA PCI. Potential mediators of this benefit include larger and more appropriately sized stents, perhaps translating into lower risk of subsequent stent thrombosis. Although residual confounding cannot be ruled out, our findings indicate a possible hazard when performing unprotected LMCA PCI without IVUS guidance.

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published
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keywords
acute coronary syndrome, angioplasty, comorbidity, percutaneous coronary intervention, thrombosis
in
Circulation: Cardiovascular Interventions
volume
10
issue
5
publisher
American Heart Association
external identifiers
  • scopus:85019602934
  • wos:000401546000010
ISSN
1941-7640
DOI
10.1161/CIRCINTERVENTIONS.116.004813
language
English
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yes
id
90ad8bb1-b2f5-4254-a9e3-7de10b7a480f
date added to LUP
2017-07-03 17:14:54
date last changed
2017-09-18 11:37:24
@article{90ad8bb1-b2f5-4254-a9e3-7de10b7a480f,
  abstract     = {<p>Background - Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study. Methods and Results - Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Of 2468 patients, IVUS guidance was used in 621 (25.2%). The IVUS group was younger (median age, 70 versus 75 years) and had fewer comorbidities but more complex lesions. IVUS was associated with larger stent diameters (median, 4 mm versus 3.5 mm). After adjusting for potential confounders, IVUS was associated with significantly lower occurrence of the primary composite end point of all-cause mortality, restenosis, or definite stent thrombosis (hazard ratio, 0.65; 95% confidence interval, 0.50-0.84) and all-cause mortality alone (hazard ratio, 0.62; 95% confidence interval, 0.47-0.82). In 340 propensity score-matched pairs, IVUS was also associated with significantly lower occurrence of the primary end point (hazard ratio, 0.54; 95% confidence interval, 0.37-0.80). Conclusions - IVUS was associated with an independent and significant outcome benefit when performing unprotected LMCA PCI. Potential mediators of this benefit include larger and more appropriately sized stents, perhaps translating into lower risk of subsequent stent thrombosis. Although residual confounding cannot be ruled out, our findings indicate a possible hazard when performing unprotected LMCA PCI without IVUS guidance.</p>},
  articleno    = {e004813},
  author       = {Andell, Pontus and Karlsson, Sofia and Mohammad, Moman A. and Götberg, Matthias and James, Stefan and Jensen, Jens and Fröbert, Ole and Angeras, Oskar and Nilsson, Johan and Omerovic, Elmir and Lagerqvist, Bo and Persson, Jonas and Koul, Sasha and Erlinge, David},
  issn         = {1941-7640},
  keyword      = {acute coronary syndrome,angioplasty,comorbidity,percutaneous coronary intervention,thrombosis},
  language     = {eng},
  month        = {05},
  number       = {5},
  publisher    = {American Heart Association},
  series       = {Circulation: Cardiovascular Interventions},
  title        = {Intravascular Ultrasound Guidance is Associated with Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared with Angiography Guidance Alone},
  url          = {http://dx.doi.org/10.1161/CIRCINTERVENTIONS.116.004813},
  volume       = {10},
  year         = {2017},
}