Is Intravascular Ultrasound Beneficial For
Percutaneous Coronary Intervention Of
Bifurcation Lesions? Evidence From A
4314-Patient Registry
Giuseppe Biondi Zoccai, University of Turin, Turin, Italy ([email protected])
Imad Sheiban, University of Turin, Turin, Italy
Enrico Romagnoli, Policlinico Casilino, Rome, Italy
Stefano De Servi, Legnano Hospital, Legnano, Italy
Corrado Tamburino, University of Catania, Catania, Italy
Antonio Colombo, Columbus Hospital & S. Raffaele University, Milan, Italy
Gennaro Sardella, University of Rome, Rome, Italy
Ernesto Lioy, Policlinico Casilino, Rome, Italy
Davide Capodanno, University of Catania, Catania, Italy
Giuseppe Sangiorgi, University of Modena, Modena, Italy
Background and Aim



Coronary bifurcations remain a challenging
lesion subset for percutaneous coronary
intervention (PCI).
It is unclear whether intravascular ultrasound
(IVUS) guidance can improve PCI results for
these lesions.
We thus aimed to compare IVUS-guided PCI
vs. standard PCI in a large registry of patients
undergoing PCI for bifurcations in the current
era.
Methods


A multicenter, retrospective study was
conducted enrolling consecutive patients
undergoing bifurcation PCI between January
2002 and January 2006 at 22 Italian centers.
The primary end-point was the long-term rate of
major adverse cardiac events (MACE, i.e.
death, myocardial infarction or target lesion
revascularization [TLR]).
Results (1)


A total of 4314 patients were included, 226
(5.2%) undergoing IVUS-guided PCI, and 4088
(94.8%) treated with standard PCI.
Early (30-day) outcomes were similar in the 2
groups, with MACE in 1.3% vs. 2.1%,
respectively, death in 0.9% vs. 1.0%, and stent
thrombosis in 0 vs. 0.6% (all p>0.05).
Results (2)


After an average follow-up of 24±15 months,
unadjusted rates of MACE were 17.7% vs.
16.4%, with death in 2.7% vs 4.9%, myocardial
infarction in 4.4% vs. 3.7%, TLR in 15.0% vs.
12.3%, and stent thrombosis in 3.1% vs. 2.7% (all
p>0.05).
Even at extensive multivariable analysis with
propensity adjustment, IVUS guidance was not
associated with any statistically significant impact
on the risk of MACE, death, myocardial infarction,
TLR (neither on the main branch nor on the side
branch), or stent thrombosis (all p>0.05).
Baseline patient characteristics
Procedural characteristics
Early and long-term outcomes
Conclusions

Despite a sound rationale to choose stent size,
optimize stent expansion and guide kissing
inflation, routine IVUS usage is not associated
with any significant clinical benefit for the
percutaneous revascularization of coronary
bifurcation lesions.
Thank you for your attention
For any correspondence:
[email protected]
For these and further slides on these topics
feel free to visit the metcardio.org website:
http://www.metcardio.org/slides.html