Coronary interventions

Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting

EuroIntervention 2020;16:210-217. DOI: 10.4244/EIJ-D-19-01057

Jose José
Jose Maria de la Torre Hernandez1, MD, PhD; Tamara Garcia Camarero1, MD; Jose Antonio Baz Alonso2, MD; Joan Antoni Gomez-Hospital3, MD, PhD; Gabriela Veiga Fernandez1; Dae-Hyun Lee Hwang1, MD; Fermin Sainz Laso1, MD; Angel Sanchez-Recalde4, MD, PhD; Armando Perez de Prado5, MD, PhD; Inigo Lozano Martinez-Luengas6, MD, PhD; Felipe Hernandez Hernandez7, MD; Sofia Gonzalez Lizarbe1, MD; Lola Gutierrez Alonso1, MD; Javier Zueco1, MD; Fernando Alfonso8, MD, PhD
1. Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain; 2. Complexo Hospitalario Universitario de Vigo-Xeral-Cíes, Vigo, Spain; 3. Hospital Universitario de Bellvitge, Barcelona, Spain; 4. Hospital Universitario La Paz, Madrid, Spain; 5. Complejo Asistencial Universitario de Leon, León, Spain; 6. Hospital Universitario de Cabueñes, Gijón, Spain; 7. Clinica Universitaria de Navarra-Madrid, Madrid, Spain; 8. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain

Aims: This study sought to investigate the prognostic effect of a protocol with optimisation targets for intravascular ultrasound (IVUS)-guided left main (LM) revascularisation.

Methods and results: A protocol was prospectively applied for IVUS-guided LM revascularisation (IVUS-PRO group) including predefined optimisation targets. Using propensity score matching, we selected as control groups patients with angiography-guided PCI (ANGIO group) and IVUS-guided PCI (IVUS group) from a large multicentre registry. The primary endpoint was a composite of cardiac death, LM-related infarction and LM revascularisation at 12 months. In each group, 124 patients with comparable characteristics were included. The incidence of the primary outcome was significantly higher in the ANGIO group compared to the IVUS-PRO group (12.9% vs 4.8%, HR 0.35, 95% CI: 0.15 to 0.82, p=0.02), but not with respect to the IVUS group (12.9% vs 8%, HR 0.51, 95% CI: 0.20 to 1.22, p=0.1), driven by a lower rate of LM revascularisation (8% in the ANGIO group, 6.4% in the IVUS group and 3.2% in the IVUS-PRO group). IVUS-PRO resulted in being an independent risk predictor (HR 0.45, 95% CI: 0.15 to 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 optimisation criteria.

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