Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions

Data from a Korean multicenter bifurcation registry

Jung Sun Kim, Myeong Ki Hong, Young Guk Ko, Donghoon Choi, Jung Han Yoon, Seung Hyuk Choi, Joo Yong Hahn, Hyeon Cheol Gwon, Myung Ho Jeong, Hyo Soo Kim, In Whan Seong, Joo Young Yang, Seung-Woon Rha, Seung Jea Tahk, Ki Bae Seung, Seung Jung Park, Yangsoo Jang

Research output: Contribution to journalArticle

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Abstract

Background: Although intravascular ultrasound (IVUS) has been widely used for complex lesions during coronary intervention, IVUS for stenting at bifurcation lesions has not been sufficiently assessed. The aim of this study was to investigate the impact of IVUS guidance on long-term clinical outcomes during drug-eluting stent (DES) implantation for bifurcation lesions. Methods: The Korean multicenter bifurcation registry listed 1,668 patients with non-left main de novo bifurcation lesions who underwent DES implantation between January 2004 and June 2006. Using propensity score matching with clinical and angiographic characteristics, 487 patients with IVUS guidance and 487 patients with angiography guidance were selected. The long-term clinical outcomes were compared between the 2 groups. Results: Baseline clinical and angiographic characteristics were well matched and showed no significant differences between the 2 groups. Two-stent technique and final kissing ballooning angioplasty were more frequently performed in the IVUS-guided group. Maximal stent diameters at both the main vessel and the side branch were larger in the IVUS-guided group. Periprocedural creatine kinase-MB elevation (>3 times of upper normal limits) was frequently observed in the angiography-guided group. The incidence of death or myocardial infarction was significantly lower in the IVUS-guided group compared to the angiography-guided group (3.8% vs 7.8%, log rank test P = .03, hazard ratio 0.44, 95% CI 0.12-0.96, Cox model P = .04). Conclusions: Intravascular ultrasound guidance during DES implantation at bifurcation lesions may be helpful to improve long-term clinical outcomes by reducing the occurrence of death or myocardial infarction.

Original languageEnglish
Pages (from-to)180-187
Number of pages8
JournalAmerican Heart Journal
Volume161
Issue number1
DOIs
Publication statusPublished - 2011 Jan 1

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Drug-Eluting Stents
Registries
Angiography
Stents
Myocardial Infarction
MB Form Creatine Kinase
Propensity Score
Angioplasty
Proportional Hazards Models
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions : Data from a Korean multicenter bifurcation registry. / Kim, Jung Sun; Hong, Myeong Ki; Ko, Young Guk; Choi, Donghoon; Yoon, Jung Han; Choi, Seung Hyuk; Hahn, Joo Yong; Gwon, Hyeon Cheol; Jeong, Myung Ho; Kim, Hyo Soo; Seong, In Whan; Yang, Joo Young; Rha, Seung-Woon; Tahk, Seung Jea; Seung, Ki Bae; Park, Seung Jung; Jang, Yangsoo.

In: American Heart Journal, Vol. 161, No. 1, 01.01.2011, p. 180-187.

Research output: Contribution to journalArticle

Kim, JS, Hong, MK, Ko, YG, Choi, D, Yoon, JH, Choi, SH, Hahn, JY, Gwon, HC, Jeong, MH, Kim, HS, Seong, IW, Yang, JY, Rha, S-W, Tahk, SJ, Seung, KB, Park, SJ & Jang, Y 2011, 'Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry', American Heart Journal, vol. 161, no. 1, pp. 180-187. https://doi.org/10.1016/j.ahj.2010.10.002
Kim, Jung Sun ; Hong, Myeong Ki ; Ko, Young Guk ; Choi, Donghoon ; Yoon, Jung Han ; Choi, Seung Hyuk ; Hahn, Joo Yong ; Gwon, Hyeon Cheol ; Jeong, Myung Ho ; Kim, Hyo Soo ; Seong, In Whan ; Yang, Joo Young ; Rha, Seung-Woon ; Tahk, Seung Jea ; Seung, Ki Bae ; Park, Seung Jung ; Jang, Yangsoo. / Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions : Data from a Korean multicenter bifurcation registry. In: American Heart Journal. 2011 ; Vol. 161, No. 1. pp. 180-187.
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abstract = "Background: Although intravascular ultrasound (IVUS) has been widely used for complex lesions during coronary intervention, IVUS for stenting at bifurcation lesions has not been sufficiently assessed. The aim of this study was to investigate the impact of IVUS guidance on long-term clinical outcomes during drug-eluting stent (DES) implantation for bifurcation lesions. Methods: The Korean multicenter bifurcation registry listed 1,668 patients with non-left main de novo bifurcation lesions who underwent DES implantation between January 2004 and June 2006. Using propensity score matching with clinical and angiographic characteristics, 487 patients with IVUS guidance and 487 patients with angiography guidance were selected. The long-term clinical outcomes were compared between the 2 groups. Results: Baseline clinical and angiographic characteristics were well matched and showed no significant differences between the 2 groups. Two-stent technique and final kissing ballooning angioplasty were more frequently performed in the IVUS-guided group. Maximal stent diameters at both the main vessel and the side branch were larger in the IVUS-guided group. Periprocedural creatine kinase-MB elevation (>3 times of upper normal limits) was frequently observed in the angiography-guided group. The incidence of death or myocardial infarction was significantly lower in the IVUS-guided group compared to the angiography-guided group (3.8{\%} vs 7.8{\%}, log rank test P = .03, hazard ratio 0.44, 95{\%} CI 0.12-0.96, Cox model P = .04). Conclusions: Intravascular ultrasound guidance during DES implantation at bifurcation lesions may be helpful to improve long-term clinical outcomes by reducing the occurrence of death or myocardial infarction.",
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T1 - Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions

T2 - Data from a Korean multicenter bifurcation registry

AU - Kim, Jung Sun

AU - Hong, Myeong Ki

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Yoon, Jung Han

AU - Choi, Seung Hyuk

AU - Hahn, Joo Yong

AU - Gwon, Hyeon Cheol

AU - Jeong, Myung Ho

AU - Kim, Hyo Soo

AU - Seong, In Whan

AU - Yang, Joo Young

AU - Rha, Seung-Woon

AU - Tahk, Seung Jea

AU - Seung, Ki Bae

AU - Park, Seung Jung

AU - Jang, Yangsoo

PY - 2011/1/1

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N2 - Background: Although intravascular ultrasound (IVUS) has been widely used for complex lesions during coronary intervention, IVUS for stenting at bifurcation lesions has not been sufficiently assessed. The aim of this study was to investigate the impact of IVUS guidance on long-term clinical outcomes during drug-eluting stent (DES) implantation for bifurcation lesions. Methods: The Korean multicenter bifurcation registry listed 1,668 patients with non-left main de novo bifurcation lesions who underwent DES implantation between January 2004 and June 2006. Using propensity score matching with clinical and angiographic characteristics, 487 patients with IVUS guidance and 487 patients with angiography guidance were selected. The long-term clinical outcomes were compared between the 2 groups. Results: Baseline clinical and angiographic characteristics were well matched and showed no significant differences between the 2 groups. Two-stent technique and final kissing ballooning angioplasty were more frequently performed in the IVUS-guided group. Maximal stent diameters at both the main vessel and the side branch were larger in the IVUS-guided group. Periprocedural creatine kinase-MB elevation (>3 times of upper normal limits) was frequently observed in the angiography-guided group. The incidence of death or myocardial infarction was significantly lower in the IVUS-guided group compared to the angiography-guided group (3.8% vs 7.8%, log rank test P = .03, hazard ratio 0.44, 95% CI 0.12-0.96, Cox model P = .04). Conclusions: Intravascular ultrasound guidance during DES implantation at bifurcation lesions may be helpful to improve long-term clinical outcomes by reducing the occurrence of death or myocardial infarction.

AB - Background: Although intravascular ultrasound (IVUS) has been widely used for complex lesions during coronary intervention, IVUS for stenting at bifurcation lesions has not been sufficiently assessed. The aim of this study was to investigate the impact of IVUS guidance on long-term clinical outcomes during drug-eluting stent (DES) implantation for bifurcation lesions. Methods: The Korean multicenter bifurcation registry listed 1,668 patients with non-left main de novo bifurcation lesions who underwent DES implantation between January 2004 and June 2006. Using propensity score matching with clinical and angiographic characteristics, 487 patients with IVUS guidance and 487 patients with angiography guidance were selected. The long-term clinical outcomes were compared between the 2 groups. Results: Baseline clinical and angiographic characteristics were well matched and showed no significant differences between the 2 groups. Two-stent technique and final kissing ballooning angioplasty were more frequently performed in the IVUS-guided group. Maximal stent diameters at both the main vessel and the side branch were larger in the IVUS-guided group. Periprocedural creatine kinase-MB elevation (>3 times of upper normal limits) was frequently observed in the angiography-guided group. The incidence of death or myocardial infarction was significantly lower in the IVUS-guided group compared to the angiography-guided group (3.8% vs 7.8%, log rank test P = .03, hazard ratio 0.44, 95% CI 0.12-0.96, Cox model P = .04). Conclusions: Intravascular ultrasound guidance during DES implantation at bifurcation lesions may be helpful to improve long-term clinical outcomes by reducing the occurrence of death or myocardial infarction.

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