Intravascular Ultrasound-Guided Percutaneous Coronary Intervention for Severely Calcified Lesions Requiring...

Intravascular ultrasound (IVUS) is an invaluable tool for accurate lesion assessment and optimal stent implantation during complex coronary interventions. This study evaluated the impact of IVUS guidance on the long-term clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) for severely calcified lesions requiring rotational atherectomy (RA).

Between January 2010 and October 2019, 511 patients from nine tertiary centers in South Korea who underwent PCI with RA using second-generation drug-eluting stents were enrolled. The primary endpoint was a composite of cardiac death or myocardial infarction (MI).

IVUS was performed in 241 (47.2%) patients. Compared with the angiography-guided PCI (A-GP) group, the IVUS-guided PCI (I-GP) group had a higher prevalence of the left main disease (23.7% vs. 5.9%; p<0.001), larger stents (3.1 mm vs. 2.9 mm; p<0.001), longer stents (72 mm vs. 61 mm; p<0.001), and more frequent post-dilation (85.4% vs. 71.9%; p<0.001). Within a median follow-up of 20 (9-39) months, compared with the A-GP group, the I-GP group had a significantly lower risk of cardiac death or MI (7.0% vs. 11.2%; hazard ratio [HR], 0.481; 95% confidence interval [CI], 0.254-0.908; p=0.024). After adjusting for potential confounders with inverse probability of treatment weighting, the I-GP group still had a significantly lower risk of cardiac death or MI, and cardiac death (HR, 0.442; 95% CI, 0.226-0.865; p=0.017, and HR, 0.413; 95% CI, 0.181-0.944; p=0.036).

IVUS guidance is likely to improve long-term clinical outcomes in patients undergoing PCI with RA for severely calcified lesions.