Comparison of immediate and intermediate-term outcomes of intravascular ultrasound-guided versus angiography-guided intervention for type C coronary lesions

Abstract

SUMMARY R ecent studies reported that suboptimal stent expansion and residual segment restenosis are related with adverse outcome. Complex lesions (i.e. American College of Cardiology/ American Heart Association class type C) are associated with lower procedural success and poorer late outcomes. Thus we investigated immediate and intermediate term clinical outcomes of IVUS guided percutaneous coronary intervention (PCI) in type C lesion with drug eluting stents compared with angiography guided PCI in a real-world practice. Our study was conducted on patients undergoing elective PCI for type C coronary lesions in cardiology department in Ain Shams University hospitals. The study included 50 patients who underwent IVUS guidance PCI for Type C lesions and 50 patients who underwent only angiographic guidance PCI for Type C lesions. We evaluated the impact of IVUS guidance on clinical outcomes of patients undergoing PCI for complex lesions defined as ACC/AHA type C. Major adverse cardiovascular events (MACE), a composite end-point of all-cause mortality, Q-wave myocardial infarction and target lesion revascularization, were compared between the 2 groups. Mean follow-up duration was 12 months. Baseline clinical characteristics were similar in both patient groups. Adding IVUS to the procedure lengthened the procedure time. On the other hand, lower amount of radiographic contrast was required in the IVUS guided group during the procedure Regarding the target coronary vessel in our study, the number of lesions in left main coronary artery, left anterior descending coronary artery, left circumflex coronary artery and right coronary artery was similar in both groups with no significant difference. In addition, the number of ostial, proximal, mid and distal lesions was similar between the two studied groups. Patients with IVUS-guided PCI underwent more direct stenting, more postdilatation, larger maximal stent diameter and greater number of implanted stents. Consequently, the final diameter stenosis was significantly better in IVUS guided group. A strategy of routine IVUS for drug-eluting stent implantation in complex coronary lesions did not improve the 1-year MACE rates. A randomized trial with a larger study population demonstrating the clinical usefulness of IVUS in complex coronary lesions intervention is required.