Long-Term Outcomes of Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention...

Intravascular ultrasound (IVUS) is a diagnostic modality providing information about lesion characteristics and optimizing results of percutaneous coronary intervention (PCI). The prognostic benefit of routine IVUS use for PCI of non-complex atherosclerotic lesions is unclear.

The purpose of this study was to estimate the long-term outcomes of IVUS-guided versus angiography-guided PCI in patients undergoing revascularization for non-complex lesions at a single institution.

We performed a single-institution, retrospective study of patients who underwent PCI for non-complex lesions between Jan 1^st, 2011 to Dec 31^st, 2018. All patients undergoing PCI were enrolled in our institutional PCI registry. Inverse propensity weighting was performed to adjust for unbalanced confounders. The follow-up period was 2 years. The primary outcome was major adverse cardiac events (MACE) defined as a composite of all-cause death, Q-wave myocardial infarction, and target-vessel revascularization (TVR). Secondary endpoints consisted of the individual components of MACE.

A total of 1,700 patients were included in this analysis. IVUS-guided PCI was more often utilized in older individuals of White race with a history of chronic lung disease and hypercholesterolemia and upon stable presentations. After adjustment, IVUS-guided PCI was not associated with a statistically significant difference in the primary outcome at two years when compared to angiography-guided PCI (9.7% vs. 11.5%, p=0.34). Analysis of the individual components of all-cause death and TVR demonstrated non-significant differences between the two groups.

IVUS-guided PCI was not associated with better two-year outcomes as compared to an angiography-guided approach for the treatment of non-complex atherosclerotic lesions. The results should be considered hypothesis generating and larger randomized studies with longer follow-up periods may be needed to further characterize the long-term sequelae of IVUS-guided vs. angiography-guided PCI for non-complex lesions.