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

Abstract

Background and objectives: 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).

Methods: 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).

Results: 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).

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