Optimal Stenting Technique for Complex Coronary Lesions: Intracoronary Imaging-Guided Pre-Dilation, Stent Sizing, and Post-Dilation
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Published on: February 18, 2020
Hanbit Park1, Jung-Min Ahn1, Do-Yoon Kang1
1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Intracoronary imaging-guided pre-dilation, stent sizing, and post-dilation (iPSP) significantly reduces cardiac events in complex coronary artery disease. This optimal drug-eluting stent implantation technique improves 3-year outcomes for challenging lesions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Optimal drug-eluting stent implantation techniques for complex coronary artery disease require long-term outcome evaluation.
- Complex coronary artery lesions present unique challenges for percutaneous coronary intervention.
Purpose of the Study:
- To compare 3-year outcomes of intracoronary imaging-guided pre-dilation, stent sizing, and post-dilation (iPSP) versus standard care in complex coronary artery lesions.
- To assess the effectiveness of the iPSP strategy in reducing adverse cardiac events in a large patient registry.
Main Methods:
- Analysis of 9,525 patients from the IRIS-DES registry undergoing PCI for complex lesions (left main, bifurcation, long, diffuse, or calcified).
- Utilized inverse probability of treatment weighting to adjust for confounding factors.
- Defined the iPSP group as patients receiving all three components: imaging-guided pre-dilation, sizing, and post-dilation.
Main Results:
- The iPSP strategy was applied in 35.4% of patients.
- At 3 years, the iPSP group showed a significantly lower rate of the primary composite outcome (cardiac death, target vessel MI, target vessel revascularization) compared to the non-iPSP group (5.6% vs. 7.9%).
- Adjusted hazard ratio for the primary outcome in the iPSP group was 0.71 (95% CI: 0.63-0.81; p < 0.001).
Conclusions:
- Intracoronary imaging-guided pre-dilation, stent sizing, and post-dilation (iPSP) is associated with reduced cardiac events at 3 years in patients with complex coronary artery stenosis.
- The iPSP strategy should be more actively employed for treating complex coronary artery lesions.
- This technique demonstrates efficacy even in the current era of advanced drug-eluting stents.
Objectives:
This study compared the 3-year outcomes of intracoronary imaging-guided pre-dilation, stent sizing, and post-dilation (iPSP) for patients with complex coronary artery lesions.
Background:
The long-term effects of the optimal drug-eluting stent implantation technique in complex coronary artery disease have not been evaluated.
Methods:
From the IRIS-DES (Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents) registry, the study evaluated 9,525 patients who underwent percutaneous coronary intervention for left main, bifurcation, long or diffuse (>30 mm), or angiographically severely calcified lesions. The primary outcome was a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. The inverse probability of treatment weighting method was used to adjust for confounding factors.
Results:
At the index procedure, intravascular ultrasound assessment PSP were performed in 8,522 (89.5%) patients, 5,141 (54.0%) patients, and 5,531 (58.1%) patients, respectively; overall, 3,374 (35.4%) patients underwent stent implantation using all 3 parts of the iPSP strategy and were defined as the iPSP group. At 3 years, the adjusted rate of the primary outcome was significantly lower in iPSP group (5.6% vs 7.9%; adjusted hazard ratio: 0.71; 95% confidence interval: 0.63 to 0.81; p < 0.001).
Conclusions:
Among patients undergoing drug-eluting stent implantation in complex coronary artery stenosis, iPSP was associated with a lower risk of cardiac events at 3 years. Therefore, physicians should apply iPSP more actively for the treatment of complex coronary artery stenoses, even in the current era. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133).
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