Intravascular ultrasound (IVUS) guidance during drug-eluting stent (DES) implantation is associated with better three-year clinical outcomes than angiography guidance, according to new findings published in JACC: Cardiovascular Interventions.[1]
The study’s authors explored data from the IVUS-XPL and ULTIMATE randomized clinical trials, focusing on the survival rates associated with IVUS- and angiography-guided long DES implantation. More than 2,500 patients from the two trials were included in this new analysis. All patients were treated with implanted stents more than 28 mm long. While the IVUS-XPL trial enrolled patients from October 2010 to July 2014, the ULTIMATE trial focused on patients treated from August 2014 to May 2017.
The team ultimately compared data from 1,289 patients who underwent IVUS-guided long DES implantation with data from another 1,288 patients who underwent angiography-guided long DES implantation.
Overall, IVUS-guided long DES implantation was associated with a lower three-year cardiac mortality rate (1%) than angiography-guided long DES implantation (2.2%). While this suggests that survival may improve when clinicians choose an IVUS-guided technique, the authors did emphasize that the difference “was not significantly different.”
“Failure to attain statistical significance may be attributed to a relatively small number of events with a small number of patients because the patients who underwent IVUS-guided DES implantation were selected for this analysis,” wrote first author Sung-Jin Hong, a specialist with Severance Cardiovascular Hospital and Yonsei University College of Medicine in South Korea, and colleagues. “These results also may depend on which IVUS optimization criteria were applied.”
The composite three-year endpoint of cardiac death, myocardial infarction or definite/probable stent thrombosis, however, was seen in 1.3% of patients from the IVUS-guided group and 2.9% of patients from the angiography-guided group. These benefits, the authors added, were consistent across all subgroups.
“The survival benefit of IVUS-guided stenting versus angiography-guided stenting warrants a larger randomized study,” the authors wrote.
Click here to read the full analysis in JACC: Cardiovascular Interventions.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.