The Application of Predefined Optimization Criteria for Intravascular Ultrasound Guidance of Left Main Stenting Improves Outcomes.
DOI: 10.4244/EIJ-D-19-01057
Jose Maria De la Torre Hernandez1, ; Tamara Garcia Camarero2; Jose A Baz Alonso3; Joan Antoni Gomez Hospital4; Gabriela Veiga Fernandez2; Dae-Hyun Lee Hwang2; Fermin Sainz Laso2; Angel Sanchez Recalde5; Armando Perez de Prado6; Iñigo Lozano7; Felipe Hernandez Hernandez8; Sofia Gonzalez Lizarbe2; Lola Gutierrez Alonso2; Javier Zueco2; Fernando Alfonso9;
1. Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain, Spain 2. Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain 3. Complexo Hospitalario Universitario de Vigo-Xeral-Cíes, Vigo, Spain 4. Hospital Universitario de Bellvitge, Barcelona, Spain 5. Hospital Universitario La Paz, Madrid, Spain 6. Complejo Asistencial Universitario de Leon, León, Spain 7. Hospital Universitario de Cabueñes, Gijón, Spain 8. Clinica Universitaria de Navarra-Madrid, Madrid, Spain 9. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
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Aims This study sought to investigate the prognostic effect of a protocol with optimization targets for intravascular ultrasound (IVUS) guided left main (LM) revascularization.
Methods and results A protocol was prospectively applied for IVUS guided LM revascularization (IVUS-PRO group) including predefined optimization targets. As control groups we selected, using propensity score matching, patients with angiography guided PCI (ANGIO group) and IVUS guided PCI (IVUS group) from a large multicenter registry. Primary endpoint was a composite of cardiac death, LM related infarction and LM revascularization at 12 months. In each group, 124 patients with comparable characteristics were included. Incidence of primary outcome was significantly higher in ANGIO group compared to IVUS-PRO group (12.9% vs. 4.8%, HR 0.35 CI 95% 0.15 to 0.82, p=0.02), but not with respect to the IVUS group (12.9% vs. 8%, HR 0.51 CI95% 0.20 to 1.22, p=0.1), driven by a lower rate of LM revascularization (8% in ANGIO group, 6.4% in IVUS group and 3.2% in IVUS-PRO group). IVUS-PRO resulted independent risk predictor (HR 0.45, 95% CI 0.15-0.98; p= 0.041).
Conclusions IVUS guidance of LM stenting provides prognostic benefit with respect to the use of angiography alone, particularly when following a protocol with these predefined optimization criteria.