The use of intravascular ultrasound (IVUS) guidance for implantation of drug-eluting stents in long lesions improved long-term cardiac survival compared with angiography-guided implantation. This is according to the findings of a patient-level data meta-analysis, published in JACC: Cardiovascular Interventions.
The authors of the paper, Sung-Jin Hong (Yonsei University College of Medicine, Seoul, South Korea) and colleagues, write that though the long-term benefit of IVUS guidance for drug-eluting stent implantation has been reported from recent randomised trials, “this benefit has been primarily driven by the reduction in repeat revascularisation”. Therefore, they add, “it remains uncertain whether IVUS guidance improved survival during long term follow-up”.
The analysis by Hong et al compared IVUS to angiographic guidance in 2,577 patients enrolled in the IVUS-XPL and ULTIMATE randomised trials with long lesions, treated with an implanted stent length ≥28mm. The primary endpoint of the analysis was cardiac death at three years.
Three-year clinical follow-up was completed in 96% of the patients, Hong et al report, noting that cardiac death occurred in 12 patients (1%) in the IVUS-guided group, compared to 28 patients (2.2%) in the angiography-guided group (hazard ratio [HR]: 0.43; 95%, confidence interval [CI] 0.22–0.84; p=0.011).
Additionally, Hong et al report that target lesion-related myocardial infarction occurred in three patients (0.2%) in the IVUS-guided group, and nine patients (0.7%) in the angiography-guided group (HR: 0.33; 95%, CI: 0.09–1.22; p=0.081), stent thrombosis developed in three patients (0.2%) in the IVUS-guided group and nine (0.7%) in the angiography-guided group (HR: 0.33; 95% CI: 0.09–1.23; p=0.082), and ischaemia-driven target lesion revascularisation was observed in 47 patients (3.8%) in the IVUS-guided group and 80 patients (6.5%) in the angiography-guided group (HR: 0.57; 95% CI: 0.40–0.82; p=0.002).
The results led the study team to conclude that the use of IVUS guidance for drug-eluting stent implantation compared with angiography guidance results in improved cardiac survival, and a “significantly lower” rate of the composite endpoint of cardiac death, myocardial infarction, or definite or probable stent thrombosis at three years among patients undergoing long coronary stent implantation.
“The survival benefit of IVUS-guided stenting versus angiography-guided stenting warrants a larger randomised study,” Hong et al conclude.