Author + information
- Received September 4, 2019
- Revision received February 20, 2020
- Accepted March 17, 2020
- Published online June 15, 2020.
- Hanbit Park, MDa,∗,
- Jung-Min Ahn, MD, PhDa,∗,
- Do-Yoon Kang, MD, PhDa,
- Jung-Bok Lee, PhDb,
- Sangwoo Park, MDa,
- Euihong Ko, MDa,
- Sang-Cheol Cho, MDa,
- Pil Hyung Lee, MDa,
- Duk-Woo Park, MD, PhDa,
- Soo-Jin Kang, MD, PhDa,
- Seung-Whan Lee, MD, PhDa,
- Young-Hak Kim, MD, PhDa,
- Cheol Whan Lee, MD, PhDa,
- Seong-Wook Park, MD, PhDa and
- Seung-Jung Park, MD, PhDa,∗ ()
- aDivision of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- bDepartment of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Seung-Jung Park, Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea.
Objectives This study compared the 3-year outcomes of intracoronary imaging–guided pre-dilation, stent sizing, and post-dilation (iPSP) for patients with complex coronary artery lesions.
Background The long-term effects of the optimal drug-eluting stent implantation technique in complex coronary artery disease have not been evaluated.
Methods From the IRIS-DES (Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents) registry, the study evaluated 9,525 patients who underwent percutaneous coronary intervention for left main, bifurcation, long or diffuse (>30 mm), or angiographically severely calcified lesions. The primary outcome was a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. The inverse probability of treatment weighting method was used to adjust for confounding factors.
Results At the index procedure, intravascular ultrasound assessment PSP were performed in 8,522 (89.5%) patients, 5,141 (54.0%) patients, and 5,531 (58.1%) patients, respectively; overall, 3,374 (35.4%) patients underwent stent implantation using all 3 parts of the iPSP strategy and were defined as the iPSP group. At 3 years, the adjusted rate of the primary outcome was significantly lower in iPSP group (5.6% vs 7.9%; adjusted hazard ratio: 0.71; 95% confidence interval: 0.63 to 0.81; p < 0.001).
Conclusions Among patients undergoing drug-eluting stent implantation in complex coronary artery stenosis, iPSP was associated with a lower risk of cardiac events at 3 years. Therefore, physicians should apply iPSP more actively for the treatment of complex coronary artery stenoses, even in the current era. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133)
↵∗ Drs. Hanbit Park and Ahn contributed equally to this work.
This work was supported by Ministry of Trade, Industry and Energy, and Korea Institute for Advancement of Technology through the Encouragement Program for the Industries of Economic Cooperation Region. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received September 4, 2019.
- Revision received February 20, 2020.
- Accepted March 17, 2020.
- 2020 American College of Cardiology Foundation
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