Comparison of one-year clinical outcomes between intravascular ultrasound-guided versus angiography-guided implantation of drug-eluting stents for left main lesions: a single-center analysis of a 1,016-patient cohort

Abstract

Xiao-Fei Gao,1,* Jing Kan,1,* Yao-Jun Zhang,1,2 Jun-Jie Zhang,1 Nai-Liang Tian,1 Fei Ye,1 Zhen Ge,1 Ping-Xi Xiao,1 Feng Chen,3 Gary Mintz,4 Shao-Liang Chen1 1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China; 2Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands; 3Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China; 4Division of Cardiology, Cardiovascular Research Foundation, Columbia University, New York, NY, USA *These authors contributed equally contributed to this work Background: The importance of intravascular ultrasound (IVUS)-guided stenting of the unprotected left main coronary artery (ULMCA) remains controversial and has not been fully studied in the subset of patients with ULMCA. This study evaluated the clinical outcome of IVUS-guided stenting using a drug-eluting stent for ULMCA. Methods: A total of 1,016 consecutive patients with ULMCA stenosis who underwent drug-eluting stent implantation from January 2006 to December 2011 were prospectively registered. The primary endpoint of this nonrandomized registry was the rate of one-year major adverse cardiac events (MACE, including cardiac death, myocardial infarction, and target vessel revascularization). Stent thrombosis served as the safety endpoint. Propensity score matching was used to calculate the adjusted event rate. Results: The unadjusted one-year MACE rate was 14.8% in the IVUS-guided group (n=337, 33.2%), significantly different from the 27.7% (P<0.001) in the angiography-guided group (n=679, 66.8%). After propensity score matching, 291 paired patients were matched between the two groups, and the difference in one-year MACE between IVUS-guided (16.2%) versus angiography-guided (24.4%) groups was still significant (P=0.014), mainly driven by decreased rates of cardiac death (1.7%) and target vessel revascularization (3.4%) in the IVUS-guided group when compared with 5.2% (P=0.023) and 10.0% (P=0.002) in the angiography-guided group, respectively. Although it did not reach significance (P=0.075), the adjusted one-year rate of stent thrombosis in the angiography-guided group was higher than in the IVUS-guided group.Conclusion: Compared with angiography guidance, IVUS-guided treatment of ULMCA using a drug-eluting stent was associated with a significant reduction of one-year cardiac death and target vessel revascularization, resulting in less frequent one-year MACE after propensity score matching. Keywords: unprotected left main, intravascular ultrasound, major adverse cardiac events