Author + information
Intravascular ultrasound (IVUS) has been used to quantitate coronary artery disease burden, understand lesion morphology and optimize PCI. Numerous trials have investigated the impact of IVUS on outcomes of coronary intervention.
Using 3615 patients from TAXUS Libertç post approval study (December 29, 2009 -March 16, 2011) demographic features, lesion, and procedural characteristics with and without IVUS guided PCI were evaluated.
IVUS was utilized in 308/3615 patients (8.5%), 8.8% of lesions and 8.5% of vessels. Patients undergoing IVUS guided PCI more often presented with stable angina (41.9% versus 29.5% P=0.001), de novo lesions (92.9% versus 95.8% P=0.017), a history of multi vessel disease (42.5% versus 34.4% P=0.004 ), vessels greater than 3.5mm (17.6% versus 9.3% P<0.001), long lesions greater than 28mm (16.7% versus 12.5% P= 0.011), LAD (46.5% versus 37.0% P<0.001). There was no increased IVUS use in patients with in-stent restenosis, ostial or left main lesions. IVUS was used less frequently in patients with STEMI (2.6% versus 10.7% P<0.001), total occlusion (2.3% versus 11.8% P<0.001), vessels 2.25mm-2.5mm in diameter (15.6% versus 26.8% P<0.001), or patients with thrombus (4.5% versus 9.7% P<0.001). Non Q-Wave MI (ARC Definition) was higher in the IVUS group (5.5 versus 1.9 P<0.001).
In this real world registry, IVUS use was more frequent in de novo lesions with stable angina, large vessels, long lesions, LAD, in the absence of thrombus and pre-deployment intervention. All cause mortality or myocardial infarction was higher in the IVUS group, suggesting a sicker population. IVUS appeared underutilized in left main, ostial, restenosis lesions or small vessels. Further study is needed to define appropriate use and indication for IVUS in PCI.
- 2013 American College of Cardiology Foundation