A Randomized Controlled Trial of Angiography Versus Intravascular Ultrasound-Directed Bare-Metal Coronary Stent Placement (The AVID Trial)

Abstract

for the AVID InvestigatorsBackground-AVID (Angiography Versus Intravascular ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of intravascular ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR). Methods and Results-After elective coronary stent placement and an optimal angiographic result (Ͻ10% stenosis), 800 patients were randomized to Angiography-or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (Ͻ10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90Ϯ2.43 mm 2 in the Angiography group and 7.55Ϯ2.82 mm 2 in the IVUS group (Pϭ0.001). In the IVUS group, only 37% with inadequate expansion (Ͻ90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (Pϭ0.08, 95% confidence level [CI], [Ϫ8.3% to 0.5%]). When vessels with a distal reference diameter Ͻ2.5 mm by core laboratory angiography measurement were excluded from analysis, the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the IVUS group (Pϭ0.01, 95% CI, [Ϫ10.6% to Ϫ1.2%]). With a prestent angiographic stenosis of Ն70%, the TLR rate was lower in the IVUS group compared with the Angiography group (3.1% versus 14.2%; Pϭ0.002; 95% CI, [Ϫ18.4% to Ϫ4.2%]). Conclusions-IVUS-directed bare-metal stent placement results in larger acute stent dimensions without an increase in complications and a significantly lower 12-month TLR rate for vessels Ն2.5 mm by angiography and for vessels with high-grade prestent stenosis. However, for the entire sample analyzed on an intention-to-treat basis, IVUS-directed bare-metal stent placement does not significantly reduce the 12-month TLR rate when compared with stent placement guided by angiography alone. In addition, IVUS evaluation of adequate stent expansion is underutilized by experienced operators. (Circ Cardiovasc Intervent. 2009;2:113-123.)

Implante de Stent guiado por ultrassom intracoronariano melhora desfechos: meta-análise de ensaios randomizados

“…Primary endpoint: Major adverse cardiac events Seven articles [5][6][7][8][9]18,19 (n = 2.186) evaluated MACE ( Figure 2). IVUS stenting was associated with a nonsignificant reduction of 21% in MACE compared to ANGIO stenting (RR: 0.79; 95% CI: 0.61-1.03; I 2 : 44%).…”

“…Analyzing individual outcomes, we observed that IVUS stenting was associated with a non-significant increase of 35% in all-cause mortality [5][6][7][8][9][18][19][20] Figure 2). Based on the GRADE approach, the overall quality of evidence was moderate for all-cause mortality (on basis of the imprecision of the results) and low for myocardial infarction (based on imprecision and the inconsistency of the results) ( Table 3).…”

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

“…However, IVUS-guided PCI could not always achieve perfect stent optimization even in noncomplex lesions. In the AVID trial 14) the number of patients that met a minimal stent area above 90% of the reference vessel was only 44%. Approximately 80% of the study population's minimum stent area was above 80% of the average of the proximal and distal reference lumen area in RESIST.…”

Optical coherence tomography- vs. intravascular ultrasound-guided percutaneous coronary intervention

“…Intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represent two techniques that provide essential information on preprocedural lesion characteristics (i.e., lesion severity, landing zone, and plaque composition) and the result after stent implantation (i.e., stent expansion and eccentricity, strut apposition, lesion coverage, tissue protrusion, and dissections). A total of 11 randomized controlled trials investigated the effect of IVUS-guided PCI with mixed results (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Of note, studies including patients with an increased complexity [i.e., chronic total occlusion (CTO) or lesion length >28 mm] demonstrated a consistent benefit of IVUS-guided PCI as compared with angiography, mainly driven by a reduction of repeat revascularization for restenosis (MACE at 1 year: CTO-IVUS, 2.6% vs. 7.1%, P=0.035; IVUS-XPL, 2.9% vs. 5.8%, P=0.007) (1,2).…”