Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry

Giuseppe Biondi-Zoccai, Imad Sheiban, Enrico Romagnoli, Stefano De Servi, Corrado Tamburino, Antonio Colombo, Francesco Burzotta, Patrizia Presbitero, Leonardo Bolognese, Leonardo Paloscia, Paolo Rubino, Gennaro Sardella, Carlo Briguori, Luigi Niccoli, Gianfranco Franco, Domenico Di Girolamo, Luigi Piatti, Cesare Greco, Davide Capodanno, Giuseppe Sangiorgi

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. Results: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). Conclusions: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.

Original languageEnglish
Pages (from-to)1021-1028
Number of pages8
JournalClinical Research in Cardiology
Volume100
Issue number11
DOIs
Publication statusPublished - Nov 2011

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Percutaneous Coronary Intervention
Registries
Stents
Thrombosis
Myocardial Infarction
Retrospective Studies
Propensity Score
Drug-Eluting Stents
Economic Inflation
Multicenter Studies

Keywords

  • Bifurcation
  • Coronary artery disease
  • Intravascular ultrasound
  • Percutaneous transluminal coronary angioplasty
  • Stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry. / Biondi-Zoccai, Giuseppe; Sheiban, Imad; Romagnoli, Enrico; De Servi, Stefano; Tamburino, Corrado; Colombo, Antonio; Burzotta, Francesco; Presbitero, Patrizia; Bolognese, Leonardo; Paloscia, Leonardo; Rubino, Paolo; Sardella, Gennaro; Briguori, Carlo; Niccoli, Luigi; Franco, Gianfranco; Girolamo, Domenico Di; Piatti, Luigi; Greco, Cesare; Capodanno, Davide; Sangiorgi, Giuseppe.

In: Clinical Research in Cardiology, Vol. 100, No. 11, 11.2011, p. 1021-1028.

Research output: Contribution to journalArticle

Biondi-Zoccai, G, Sheiban, I, Romagnoli, E, De Servi, S, Tamburino, C, Colombo, A, Burzotta, F, Presbitero, P, Bolognese, L, Paloscia, L, Rubino, P, Sardella, G, Briguori, C, Niccoli, L, Franco, G, Girolamo, DD, Piatti, L, Greco, C, Capodanno, D & Sangiorgi, G 2011, 'Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry', Clinical Research in Cardiology, vol. 100, no. 11, pp. 1021-1028. https://doi.org/10.1007/s00392-011-0336-x
Biondi-Zoccai, Giuseppe ; Sheiban, Imad ; Romagnoli, Enrico ; De Servi, Stefano ; Tamburino, Corrado ; Colombo, Antonio ; Burzotta, Francesco ; Presbitero, Patrizia ; Bolognese, Leonardo ; Paloscia, Leonardo ; Rubino, Paolo ; Sardella, Gennaro ; Briguori, Carlo ; Niccoli, Luigi ; Franco, Gianfranco ; Girolamo, Domenico Di ; Piatti, Luigi ; Greco, Cesare ; Capodanno, Davide ; Sangiorgi, Giuseppe. / Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry. In: Clinical Research in Cardiology. 2011 ; Vol. 100, No. 11. pp. 1021-1028.
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abstract = "Background: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. Results: A total of 4,314 patients were included, 226 (5.2{\%}) undergoing IVUS-guided PCI, and 4,088 (94.8{\%}) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1{\%}, respectively, death in 0.9 versus 1.0{\%}, and stent thrombosis in 0 versus 0.6{\%} (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4{\%}, with death in 2.7 versus 4.9{\%}, myocardial infarction in 4.4 versus 3.7{\%}, TLR in 15.0 versus 12.3{\%}, and stent thrombosis in 3.1 versus 2.7{\%} (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). Conclusions: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.",
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T1 - Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry

AU - Biondi-Zoccai, Giuseppe

AU - Sheiban, Imad

AU - Romagnoli, Enrico

AU - De Servi, Stefano

AU - Tamburino, Corrado

AU - Colombo, Antonio

AU - Burzotta, Francesco

AU - Presbitero, Patrizia

AU - Bolognese, Leonardo

AU - Paloscia, Leonardo

AU - Rubino, Paolo

AU - Sardella, Gennaro

AU - Briguori, Carlo

AU - Niccoli, Luigi

AU - Franco, Gianfranco

AU - Girolamo, Domenico Di

AU - Piatti, Luigi

AU - Greco, Cesare

AU - Capodanno, Davide

AU - Sangiorgi, Giuseppe

PY - 2011/11

Y1 - 2011/11

N2 - Background: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. Results: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). Conclusions: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.

AB - Background: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. Results: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). Conclusions: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.

KW - Bifurcation

KW - Coronary artery disease

KW - Intravascular ultrasound

KW - Percutaneous transluminal coronary angioplasty

KW - Stent

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