Does Ultrasound-Guided Stenting Improve Outcomes with Coronary Artery Disease?

Intravascular ultrasound (IVUS)-guided stenting was found to improve 3-year mortality and MI outcomes in patients with unprotected left main coronary artery (LMCA) disease, according to a new study.

The study included a total of 1899 patients with LMCA, 713 (37.5%) of whom underwent IVUS-guided stenting and 1186 (62.5%) of whom underwent conventional angiography-guided stenting. Composite all-cause mortality and myocardial infarction (MI) after 3 years was assessed as the primary outcome, and target vessel revascularization (TVR) was assessed as the secondary outcome.
_____________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Study Questions Beta-Blockers for Stable Angina After PCI
New Options for Angina, Metastatic Breast Cancer, HCV
_____________________________________________________________________________________________________________________________________________________________

In unadjusted analysis, the researchers found a trend towards lower composite all-cause mortality and MI in patients who underwent IVUS-guided stenting at 3 years compared with angiography-guided stenting (6.9% vs 8.4%, respectively). However, TVR was found to be similar between the groups (6% and 6%, respectively).

Further adjustments for baseline risk factors showed that IVUS-guidance was associated with significantly lower incidence of composite all-cause mortality and MI (hazard ratios 0.65 and 0.5, respectively), but TVR outcomes remained similar between the groups.

“IVUS-guided stenting had a benefit in reducing long-term mortality rates compared with angiography-guided stenting for unprotected LMCA stenosis,” the researchers concluded. “Further randomized controlled trials with larger sample size are needed to further address the real advantages of IVUS over angiography guidance in unprotected LMCA disease.”

—Melissa Weiss

Reference:

Tian J, Guan C, Wang W, et al. Intravascular ultrasound guidance improves the long-term prognosis in patients with unprotected left main coronary artery disease undergoing percutaneous coronary intervention [published online May 24, 2017]. Nature. doi:10.1038/s41598-017-02649-5.