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Background: Uncertainty remains regarding the associations of angiographic optimization and intravascular ultrasound (IVUS) optimization after new-generation drug-eluting stent (DES) implantation.

Methods: From four randomized trials comparing outcomes between IVUS and angiography-guidance for long or chronic total occlusion (CTO) lesions, 1396 patients who underwent IVUS-guided new-generation DES implantation were enrolled. Of these, 1112 patients (80%) met angiographic optimization criteria (postprocedural diameter stenosis, ≤20%) and were further classified into the matched (same results for angiographic optimization and IVUS optimization) and the mismatched group (opposite results for angiographic optimization and IVUS optimization) according to the meeting of IVUS optimization criteria (minimal stent area, ≥5.5 mm2 or ≥80% of mean reference lumen area). The major adverse clinical events (MACE) were compared.

Results: Of 1112 patients with angiographic optimization, 675 patients met the IVUS optimization criteria (61%; matched), but 437 patients (39%; mismatched) failed to meet IVUS optimization criteria (false-positive rate = 76%). On multivariate analyses, age >60 years, reference vessel diameter ≤2.7 mm, left circumflex artery and lesion length ≥33 mm were significant predictors for the mismatched. When comparing the 12-month MACE rates, the mismatched group (6.8%) showed a significantly higher rate than the matched group (1.5%; hazard ratio = 2.62; 95% confidence interval = 1.20-5.72; P = 0.012), mainly driven by a higher target-vessel revascularization rate (6.4 vs 1.4%; P = 0.021).

Conclusion: Despite meeting angiographic optimization criteria in long or CTO lesions, more than one-third of the patients with IVUS-guided new-generation DES implantation failed to meet the IVUS optimization criteria and had worse clinical outcomes. Therefore, IVUS optimization should be considered for patients who had predictors of mismatch.

Titel:	Association between angiographic and intravascular ultrasound optimizations after new-generation drug-eluting stent implantation and clinical outcomes.
Autor/in / Beteiligte Person:	Cha, JJ ; Kim, D ; Kim, BK ; Hong, SJ ; Ahn, CM ; Kim, JS ; Ko, YG ; Choi, D ; Hong, MK ; Jang, Y
Link:	Full Text Finder (Volltext)
Zeitschrift:	Coronary artery disease, Jg. 32 (2021-09-01), Heft 6, S. 541-548
Veröffentlichung:	London : Lippincott Williams & Wilkins ; <i>Original Publication</i>: Philadelphia, Pa. : Current Science, c1990-, 2021
Medientyp:	academicJournal
ISSN:	1473-5830 (electronic)
DOI:	10.1097/MCA.0000000000001007
Schlagwort:	Aged Female Humans Male Middle Aged Randomized Controlled Trials as Topic Coronary Angiography Coronary Artery Disease diagnostic imaging Coronary Artery Disease drug therapy Drug-Eluting Stents Percutaneous Coronary Intervention Ultrasonography, Interventional
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Coron Artery Dis] 2021 Sep 01; Vol. 32 (6), pp. 541-548. MeSH Terms: Coronary Angiography* ; Drug-Eluting Stents* ; Percutaneous Coronary Intervention* ; Ultrasonography, Interventional* ; Coronary Artery Disease / diagnostic imaging ; Coronary Artery Disease / drug therapy ; Aged ; Female ; Humans ; Male ; Middle Aged ; Randomized Controlled Trials as Topic References: Kim JS, Kang TS, Mintz GS, Park BE, Shin DH, Kim BK, et al. Randomized comparison of clinical outcomes between intravascular ultrasound and angiography-guided drug-eluting stent implantation for long coronary artery stenoses. JACC Cardiovasc Interv. 2013; 6:369–376. ; Kim BK, Shin DH, Hong MK, Park HS, Rha SW, Mintz GS, et al.; CTO-IVUS Study Investigators. 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Association between angiographic and intravascular ultrasound optimizations after new-generation drug-eluting stent implantation and clinical outcomes.