Yong-Joon Lee, Jun-Jie Zhang, Gary S Mintz, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Jing Kan, Tao Pan, Xiaofei Gao, Zhen Ge, Shao-Liang Chen, Myeong-Ki Hong
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The primary end point was composite of cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 3 years.</p><p><strong>Results: </strong>Postintervention quantitative coronary angiography-based minimum lumen diameter was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (2.5±0.4 mm versus 2.5±0.4 mm; <i>P</i>=0.367). However, it was larger in the IVUS guidance with postdilation versus the angiography guidance without postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; <i>P</i>=0.046), and also in the IVUS guidance with postdilation versus the angiography guidance with postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; <i>P</i><0.001). The rate of the primary end point was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (8.6% versus 9.8%; hazard ratio, 0.86 [95% CI, 0.58-1.29]; <i>P</i>=0.473). However, it was lower after IVUS guidance with postdilation versus angiography guidance without postdilation (4.5% versus 9.8%; hazard ratio, 0.44 [95% CI, 0.28-0.68]; <i>P</i><0.001) and also after IVUS guidance with postdilation versus angiography guidance with postdilation (4.5% versus 8.6%; hazard ratio, 0.51 [95% CI, 0.35-0.74]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>In patients undergoing long drug-eluting stent implantation, IVUS-guided postdilation was associated with improved long-term clinical outcomes, unlike angiography-guided postdilation.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. 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The primary end point was composite of cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 3 years.</p><p><strong>Results: </strong>Postintervention quantitative coronary angiography-based minimum lumen diameter was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (2.5±0.4 mm versus 2.5±0.4 mm; <i>P</i>=0.367). However, it was larger in the IVUS guidance with postdilation versus the angiography guidance without postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; <i>P</i>=0.046), and also in the IVUS guidance with postdilation versus the angiography guidance with postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; <i>P</i><0.001). The rate of the primary end point was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (8.6% versus 9.8%; hazard ratio, 0.86 [95% CI, 0.58-1.29]; <i>P</i>=0.473). However, it was lower after IVUS guidance with postdilation versus angiography guidance without postdilation (4.5% versus 9.8%; hazard ratio, 0.44 [95% CI, 0.28-0.68]; <i>P</i><0.001) and also after IVUS guidance with postdilation versus angiography guidance with postdilation (4.5% versus 8.6%; hazard ratio, 0.51 [95% CI, 0.35-0.74]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>In patients undergoing long drug-eluting stent implantation, IVUS-guided postdilation was associated with improved long-term clinical outcomes, unlike angiography-guided postdilation.</p>\",\"PeriodicalId\":516631,\"journal\":{\"name\":\"Circulation. 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引用次数: 4
摘要
背景:有两种相互竞争的方法来优化药物洗脱支架植入术:血管造影引导的常规扩张或血管内超声(IVUS)引导。方法:从IVUS- xpl(血管内超声引导对Xience Prime支架在长病变中的结果的影响)和ULTIMATE(血管内超声引导药物洗脱支架植入在全角冠状动脉病变中的影响)两项随机试验的合并数据中，我们比较了IVUS与血管造影引导药物洗脱支架植入术中的1037例患者(1265个病变)与IVUS引导下的后扩张，905例患者(1170个病变)与血管造影引导下的后扩张，以383例(397个病变)血管造影引导下药物洗脱支架置入术无后扩张为参照组;所有患者均需要≥28mm长的支架。主要终点是3年心脏死亡、靶病变相关心肌梗死或缺血驱动靶病变血运重建的复合终点。结果:介入后定量冠脉造影的最小管腔直径在有扩张的血管造影指导组和没有扩张的血管造影指导组之间没有差异(2.5±0.4 mm vs 2.5±0.4 mm;P = 0.367)。然而，有扩张的IVUS引导组比没有扩张的血管造影引导组更大(2.6±0.5 mm比2.5±0.4 mm;P=0.046)，以及扩张后IVUS引导组与扩张后血管造影引导组(2.6±0.5 mm vs 2.5±0.4 mm;页= 0.473)。然而，有后扩张的IVUS指导比没有后扩张的血管造影指导更低(4.5%对9.8%;风险比，0.44 [95% CI, 0.28-0.68];ppp结论:在接受长期药物洗脱支架植入术的患者中，与血管造影引导下的后扩张不同，ivus引导下的后扩张与改善的长期临床结果相关。
Is Routine Postdilation During Angiography-Guided Stent Implantation as Good as Intravascular Ultrasound Guidance?: An Analysis Using Data From IVUS-XPL and ULTIMATE.
Background: There are 2 competing approaches to optimize drug-eluting stent implantation: angiography-guided routine postdilation or intravascular ultrasound (IVUS) guidance.
Methods: From the pooled data of 2 randomized trials, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), that compared IVUS- versus angiography-guided drug-eluting stent implantation, we compared 1037 patients (1265 lesions) with IVUS-guided postdilation, 905 patients (1170 lesions) with angiography-guided postdilation, and 383 patients (397 lesions) with angiography-guided drug-eluting stent implantation without postdilation as a reference group; all patients required ≥28 mm long stents. The primary end point was composite of cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 3 years.
Results: Postintervention quantitative coronary angiography-based minimum lumen diameter was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (2.5±0.4 mm versus 2.5±0.4 mm; P=0.367). However, it was larger in the IVUS guidance with postdilation versus the angiography guidance without postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P=0.046), and also in the IVUS guidance with postdilation versus the angiography guidance with postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P<0.001). The rate of the primary end point was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (8.6% versus 9.8%; hazard ratio, 0.86 [95% CI, 0.58-1.29]; P=0.473). However, it was lower after IVUS guidance with postdilation versus angiography guidance without postdilation (4.5% versus 9.8%; hazard ratio, 0.44 [95% CI, 0.28-0.68]; P<0.001) and also after IVUS guidance with postdilation versus angiography guidance with postdilation (4.5% versus 8.6%; hazard ratio, 0.51 [95% CI, 0.35-0.74]; P<0.001).
Conclusions: In patients undergoing long drug-eluting stent implantation, IVUS-guided postdilation was associated with improved long-term clinical outcomes, unlike angiography-guided postdilation.
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