Long-Term Outcomes of Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention for Non-Complex Atherosclerotic Lesions.

BACKGROUND

Intravascular ultrasound (IVUS) is a diagnostic modality providing information about lesion characteristics and optimizing results of percutaneous coronary intervention (PCI). The prognostic benefit of routine IVUS use for PCI of non-complex atherosclerotic lesions is unclear.

OBJECTIVES

The purpose of this study was to estimate the long-term outcomes of IVUS-guided versus angiography-guided PCI in patients undergoing revascularization for non-complex lesions at a single institution.

METHODS

We performed a single-institution, retrospective study of patients who underwent PCI for non-complex lesions between Jan 1st, 2011 to Dec 31st, 2018. All patients undergoing PCI were enrolled in our institutional PCI registry. Inverse propensity weighting was performed to adjust for unbalanced confounders. The follow-up period was 2 years. The primary outcome was major adverse cardiac events (MACE) defined as a composite of all-cause death, Q-wave myocardial infarction, and target-vessel revascularization (TVR). Secondary endpoints consisted of the individual components of MACE.

RESULTS

A total of 1,700 patients were included in this analysis. IVUS-guided PCI was more often utilized in older individuals of White race with a history of chronic lung disease and hypercholesterolemia and upon stable presentations. After adjustment, IVUS-guided PCI was not associated with a statistically significant difference in the primary outcome at two years when compared to angiography-guided PCI (9.7% vs. 11.5%, p=0.34). Analysis of the individual components of all-cause death and TVR demonstrated non-significant differences between the two groups.

CONCLUSIONS

IVUS-guided PCI was not associated with better two-year outcomes as compared to an angiography-guided approach for the treatment of non-complex atherosclerotic lesions. The results should be considered hypothesis generating and larger randomized studies with longer follow-up periods may be needed to further characterize the long-term sequelae of IVUS-guided vs. angiography-guided PCI for non-complex lesions.