Intravascular ultrasound (IVUS) offers tomographic images of the coronary artery,
helping physicians to refine drug-eluting stent (DES) implantation in angiographically
complex lesions. However, controversy exists regarding whether the routine use of
IVUS in short-length lesions leads to improved clinical outcomes after DES implantation.
Therefore, we evaluated the usefulness of IVUS in predicting major adverse cardiac
events (MACE), including cardiovascular death, myocardial infarction, or target vessel
revascularization, at 1 year after DES implantation in short-length lesions. The present
study was a subanalysis of the REal Safety and Efficacy of a 3-month dual antiplatelet
Therapy following Endeavor zotarolimus-eluting stent implantation (RESET) study with
different clinical outcome parameters. The study population consisted of 662 patients
with IVUS guidance and 912 patients with angiography guidance who underwent DES implantation
(stent length ≤24 mm). In the IVUS-guided group, adjuvant postdilation was more frequently
performed (43.0% vs 34.6%, p <0.001), and the postintervention minimal lumen diameters
were greater (2.88 ± 0.44 mm vs 2.72 ± 0.43 mm, p <0.001). MACE occurred in 15 IVUS-guided
(2.3%) and 19 angiographically guided (2.1%) patients (p = 0.872). In a subset of
patients with diabetes mellitus (n = 292), the MACE rate was 3.4% (n = 4) and 1.7%
(n = 3) in the IVUS- and angiographically guided patients, respectively (p = 0.384).
The MACE rate in the IVUS- and angiographically guided patients with acute coronary
syndrome (n = 601) was 1.1% (n = 3) and 2.7% (n = 9), respectively (p = 0.194). The
clinical benefits of IVUS-guided DES implantation compared with angiographically guided
DES implantation in short-length lesions could not be confirmed even in patients with
clinically high-risk presentations (acute coronary syndrome and diabetes mellitus).
In conclusion, routine IVUS guidance does not provide clinical benefits when performing
short-length DES implantation.
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Article Info
Publication History
Published online: May 28, 2013
Accepted:
April 19,
2013
Received in revised form:
April 19,
2013
Received:
February 24,
2013
Footnotes
Drs. Yoon and Shin contributed equally to this report.
This study was supported by the Cardiovascular Research Center (Seoul, South Korea) , grants A085012 and A102064 from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs (Seoul, South Korea) , and grant A085136 from the Korea Health 21 R&D Project, Ministry of Health & Welfare (Seoul, South Korea) .
See page 645 for disclosure information.
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