期刊
JACC-CARDIOVASCULAR INTERVENTIONS
卷 14, 期 3, 页码 247-257出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2020.10.001
关键词
drug-eluting stent; intravascular ultrasound; target vessel failure; all-comers
资金
- National Natural Science Foundation of China [NSFC 81970307]
- Six Talent Peaks Project of Jiangsu Province [2019WSN156]
- Social Development Project of Jiangsu Province [BE2019616]
- Jiangsu Commission of Health [H2019077]
- Jiangsu Provincial Special Program of Medical Science [BE2019615]
- Nanjing Commission of Health [ZKX19027]
- Nanjing Health Youth Talent Training project [QRX 17017]
This study aimed to compare the difference in target vessel failure (TVF) at 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance for second-generation drug-eluting stent (DES) implantation in all comers. The results showed that IVUS-guided DES implantation significantly reduced the rates of TVF and stent thrombosis (ST) at 3 years, particularly when the IVUS-defined optimal procedure was followed.
OBJECTIVES The aim of this study was to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance among all comers undergoing second-generation drug-eluting stent (DES) implantation. BACKGROUND The multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions) trial showed a lower incidence of 1-year TVF after IVUS-guided DES implantation among all comers compared with angiographic guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown. METHODS A total of 1,448 all comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiographic guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk for TVF at 3 years. The safety endpoint was definite or probable stent thrombosis (ST). RESULTS At 3 years, TVF occurred in 47 patients (6.6%) in the IVUS-guided group and in 76 patients (10.7%) in the angiography-guided group (p = 0.01), driven mainly by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%; p = 0.05). The rate of definite or probable ST was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure. CONCLUSIONS IVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during 3 year follow-up among all comers, particularly those who underwent the IVUS-defined optimal procedure compared with those with angiographic guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions; NCT02215915) (J Am Coll Cardiol Intv 2021;14:247-57) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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