Clinical Impact of Intravascular Ultrasound Guidance in Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Disease

Hernández, José M. de la Torre; Alonso, José Antonio Baz; Manterola, Fernando Alfonso; Camarero, Tamara García; Carlos, Federico Gimeno de; Ferrer, Gerard Roura; Recalde, Ángel Sánchez; Martínez-Luengas, Íñigo Lozano; Gomez‐Lara, Josep; Hernández, Felipe; Pérez-Vizcayno, Marı́a José; Cequier, Ángel; Prado, Armando Pérez de; Gonzalez‐Trevilla, Agustín Albarrán; Navarro, Manuel F. Jiménez; Ferré, Josepa Mauri; Fernández-Díaz, José Antonio; Bermúdez, Eduardo Pinar; Gil, Javier Zueco; study, Ivus-Tronco-Icp Spanish

doi:10.1016/j.jcin.2013.09.014

Cited by 210 publications

(94 citation statements)

References 21 publications

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“…Although our study design cannot determine a cause and effect relationship, this observation supports guideline recommendations that careful attention to the coronary anatomy and stent deployment are central to good outcomes. Even so, it is possible that in our study, more stable, lower risk, patients were more likely to receive IVUS and FFR 17 18…”

Section: Discussionmentioning

confidence: 75%

Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention

Alabas

Brogan

Hall

et al. 2016

Heart

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Tel: 0044 (0)113 343 8905 2 Study design:Prospective population-based linked cohort study using data from the British Cardiovascular Intervention Society (BCIS) database, January 2005 to July 2014. Details of funding:MH and TBD are funded by the British Heart Foundation (Project Grant PG/13/81/30474). Conflicts of interest:Curzen N declares unrestricted research grants from Boston Scientific, HeartFlow, Haemonetics, Medtronic, St Jude Medical, and speaker fees/consultancy from St Jude Medical, HeartFlow, Haemonetics, Lilly/D-S. All other authors declare no conflicts of interest. Word count:Abstract 250 Text, excluding abstract 2839 References: 21Tables: 2 Figures: 5 3 Key questions What is already known about this subject?Mortality after PCI to the unprotected left main stem (UPLMS) is higher among emergency and urgent cases than elective cases and it is especially high among patients with cardiogenic shock. Following PCI, however, the dominant cause of death is noncardiovascular. What does this study add?After adjusting for background population mortality, we found that long-term survival following UPLMS PCI for elective cases was excellent, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI without cardiogenic shock, the requirement for pre-procedural ventilation was the strongest determinant of excess mortality. For STEMI with cardiogenic shock, where survival was poor, the strongest determinant was TIMI flow. How might this impact on clinical practice?Greater attention to specific determinants of excess mortality, such as diabetes, renal failure and coronary anatomy, according to whether a case is emergent, urgent or elective will help improve survival following UPLMS PCI. Knowledge of clinical presentation-specific factors associated with excess mortality will allow better forecasting of outcomes for patients with ResultsOver 26,105 person-years follow-up, crude five year relative survival was 93.8% for CSA, 73.1% NSTEACS, 77.5% STEMI-CS and 28.5% STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73,, and for NSTEACS and STEMI-CS was pre-procedural ventilation (6.25, 5.05-7.75 and 6.92, 4.25-11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural TIMI 0 flow (2.78, 1.87-4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61-0.90). ConclusionsLong term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and

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Section: Discussionmentioning

confidence: 75%

Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention

Alabas

Brogan

Hall

et al. 2016

Heart

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“…De La Torre Hernandez et al . reported a better survival free of cardiac death, MI, and TLR at 3 years in the IVUS-guided group vs. the angiography-guided group with a lower incidence of definite and probable ST 8 . More importantly, the sole randomized clinical trial specifically addressing patients with LMCA disease, albeit in only 123 patients, showed that IVUS guidance was associated with a reduction in 2-year major adverse cardiac events from 29.3% to 13.1% (p = 0.031) as well as a reduction in TLR from 24.0% to 9.1% (p = 0.045) 7 .…”

Section: Discussionmentioning

confidence: 94%

“…De La Torre Hernandez et al . reported that IVUS guidance was especially beneficial in patients with distal bifurcation lesions 8 . Our results also showed that the patients in the IVUS-guided group had much lower post-procedure residual SYNTAX Scores than conventional angiography-guided group (3.65 ± 4.66 vs. 4.60 ± 5.59, p < 0.01) even though their pre-procedure SYNTAX scores were similar (23.7 ± 7.1 vs. 24.1 ± 7.1, p = 0.21).…”

Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound Guidance Improves the Long-term Prognosis in Patients with Unprotected Left Main Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Tian

Guan

Wang

et al. 2017

Sci Rep

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This study compared the long term outcomes in patients with unprotected left main coronary artery (LMCA) disease who underwent stenting under the guidance of intravascular ultrasound (IVUS) or conventional angiography at a large single center. The primary outcome was the composite of all-cause death and myocardial infarction (MI) at 3 years. Target vessel revascularization (TVR) at 3 years was one of the secondary outcomes. Between January 2004 and December 2011, a total of 1,899 patients who underwent IVUS-guided (n = 713, 37.5%) or conventional angiography-guided (n = 1186, 62.5%) stenting were included. At 3 years, the unadjusted primary outcome trended lower in the IVUS-guided group versus the angiography-guided (6.9% vs. 8.4%, p = 0.22) although the TVR was similar between two groups (6.0% vs. 6.0%, p = 0.97). However, after adjustment for differences in baseline risk factors, IVUS-guidance was associated with significantly lower incidence of the composite of all-cause death and MI (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.50 to 0.84; p = 0.001), although there was still no significant difference in TVR between the two groups (HR: 1.09; 95% CI: 0.84 to 1.42; p = 0.53). IVUS guidance has benefits in improving the long-term prognosis for unprotected LMCA stenting.

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“…The improved outcomes with PCI relative to CABG observed over time in this study cannot simply be ascribed to differences in stent type. Concomitant with evolution in stent selection, numerous other procedural changes occurred in PCI strategy, including treatment of more lesions (and with more stents), treatment of a greater proportion of patients with ULM distal bifurcation involvement (but more often with the simpler 1-stent cross-over technique), more frequent use of intravascular ultrasound imaging (which has been associated with reduced stent thrombosis and improved event-free survival after ULM stenting), 16 and improved chronic medical treatments, including dual antiplatelet therapy and statins. Moreover, the practice of CABG evolved over time as well, with greater use of off-pump surgery, more frequent grafting with the left internal mammary artery, and also improved chronic pharmacotherapy.…”

Section: Stonementioning

confidence: 99%

“…1,2 That era also witnessed the completion of 2 randomized controlled trials (RCTs) of coronary artery bypass graft surgery (CABG) versus medical therapy, still the only such studies performed to date, which demonstrated (in a grand total of 150 randomized patients) that CABG reduced 5-year mortality from 36.5% to 16.0% (P=0.004), with mean survival increased by ≈1.7 years per patient. 1 These results were subsequently confirmed in the nonrandomized Coronary Artery Surgery Study (CASS) registry in 1484 patients, 2 as well as in other observational studies.…”

mentioning

confidence: 99%

Left Main Revascularization

Stone

2015

Circ: Cardiovascular Interventions

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Clinical Impact of Intravascular Ultrasound Guidance in Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Disease

Abstract: The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES.

Cited by 210 publications

References 21 publications

Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention

Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention

Intravascular Ultrasound Guidance Improves the Long-term Prognosis in Patients with Unprotected Left Main Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Left Main Revascularization

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