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Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary

Yong Hoon Kim1, Ae-Young Her1, Seung-Woon Rha2,3

  • 1Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine.

International Heart Journal
|October 3, 2017
PubMed

Insights

Angiography-guided percutaneous coronary intervention (PCI) for non-complex left main coronary artery disease using drug-eluting stents showed similar 3-year outcomes to intravascular ultrasound (IVUS)-guided PCI. Angiography guidance is a viable option for selected cases.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Limited long-term data exists comparing angiography- versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for non-complex left main coronary artery (LMCA) disease using single stenting in the drug-eluting stent (DES) era.
  • Intravascular imaging guidance is often considered optimal for LMCA stenting, but its superiority over angiography alone in specific scenarios remains under investigation.

Purpose of the Study:

  • To compare the 3-year clinical outcomes of angiography-guided versus IVUS-guided single stenting in patients with non-complex LMCA disease.
  • To determine if angiography-guided PCI is non-inferior to IVUS-guided PCI in preventing major adverse cardiac events (MACE).

Main Methods:

  • A prospective study included 196 patients with non-complex LMCA disease undergoing single stenting, divided into angiography-guided (n=74) and IVUS-guided (n=122) groups.
  • The primary endpoint was MACE, defined as total death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR).
  • Propensity score (PS) adjusted analysis was performed to control for potential confounders.

Main Results:

  • During 3-year follow-up, no significant difference was observed in PS-adjusted rates of total death, cardiac death, or MI between the angiography-guided and IVUS-guided groups.
  • Rates of TLR and combined TVR/Non-TVR were also comparable between the two groups.
  • The overall MACE rate was not significantly different (HR: 0.63, 95% CI: 0.33-1.17; P=0.149), suggesting similar efficacy.

Conclusions:

  • Angiography-guided single stenting for non-complex LMCA disease demonstrates comparable 3-year clinical outcomes to IVUS-guided stenting in the DES era.
  • While IVUS guidance is ideal, angiography guidance can be a suitable alternative for LMCA PCI in carefully selected patients.
  • These findings support the consideration of angiography guidance in specific LMCA interventions, potentially broadening treatment accessibility.

Keywords:
Drug eluting stentsIntravascular ultrasoundLeft main coronary arteryPercutaneous coronary intervention

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