Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone

• DOI: 10.1161/circinterventions.116.004813
• Publication Date: 2017-05-10T01:00:20Z
• Authors: Pontus Andell; Sofia Karlsson; Moman A. Mohammad; Matthias Götberg; Stefan James; Jens Jensen; Ole Fröbert; Oskar Angerås; Johan Nilsson; Elmir Omerovic; Bo Lagerqvist; Jonas Persson; Sasha Koul; David Erlinge
• Keywords: Intravascular Ultrasound

Background— Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied impact of IVUS on in patients undergoing LMCA PCI a Swedish nationwide study. Methods Results— Patients who underwent between 2005 2014 because stable disease or acute syndrome were included from SCAAR (Swedish Coronary Angiography Angioplasty Registry). Of 2468 patients, was used 621 (25.2%). The group younger (median age, 70 versus 75 years) had fewer comorbidities more complex lesions. associated larger stent diameters (median, 4 mm 3.5 mm). After adjusting for potential confounders, significantly lower occurrence primary composite end point all-cause mortality, restenosis, definite thrombosis (hazard ratio, 0.65; 95% confidence interval, 0.50–0.84) mortality alone 0.62; 0.47–0.82). In 340 propensity score–matched pairs, also 0.54; 0.37–0.80). Conclusions— an independent significant benefit PCI. Potential mediators this include appropriately sized stents, perhaps translating into risk subsequent thrombosis. Although residual confounding cannot be ruled out, our findings indicate possible hazard without guidance.