Author + information
- Xiao-Fei Gao, MDa,
- Zhen Ge, MDa,
- Xiang-Quan Kong, PhDa,
- Jing Kan, MBBSa,
- Leng Han, MDb,
- Shu Lu, MDc,
- Nai-Liang Tian, MDa,
- Song Lin, MDa,
- Qing-Hua Lu, MDd,
- Xiao-Yan Wang, MDe,
- Qi-Hua Li, MDf,
- Zhi-Zhong Liu, PhDa,
- Yan Chen, MDg,
- Xue-Song Qian, MDh,
- Juan Wang, MDb,
- Da-Yang Chai, MDc,
- Chong-Hao Chen, MDe,
- Tao Pan, MBBSa,
- Fei Ye, MDa,
- Jun-Jie Zhang, MD, PhDa,∗∗ (, )
- Shao-Liang Chen, MD, PhDa,∗ (, )
- for the ULTIMATE Investigators
- aDepartment of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- bDepartment of Cardiology, Changshu No. 1 People’s Hospital, Changshu, China
- cDepartment of Cardiology, The First People’s Hospital of Taicang, Taicang, China
- dDepartment of Cardiology, The Second Hospital of Shandong University, Jinan, China
- eDepartment of Cardiology, Wuxi Third People’s Hospital, Wuxi, China
- fDepartment of Cardiology, Changzhou Traditional Chinese Medicine Hospital, Changzhou, China
- gDepartment of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
- hDepartment of Cardiology, The First People’s Hospital of Zhangjiagang, Zhangjiagang, China
- ↵∗Address for Correspondence: Dr. Shao-Liang Chen and Department of Cardiology Nanjing First Hospital Nanjing Medical University No. 68 Changle Road 210006 Nanjing, China.
- ↵∗∗Dr. Jun-Jie Zhang Department of Cardiology Nanjing First Hospital Nanjing Medical University No. 68 Changle Road 210006 Nanjing, China.
Objectives This study aimed to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiography guidance for all-comers undergoing second-generation drug-eluting stent (DES) implantation.
Background The multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions) trial showed fewer 1-year TVFs after IVUS-guided DES implantation for all-comers compared with those after angiography guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown.
Methods A total of 1448 all-comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiography guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk of TVF at 3 years. The safety endpoint was definite / probable stent thrombosis (ST).
Results At 3 years, TVF occurred in 47 (6.6%) patients in the IVUS-guided group and in 76 (10.7%) patients in the angiography-guided group (p = 0.01), mainly driven by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%, p = 0.05). The definite or probable ST rate was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure.
Conclusions IVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during a 3-year follow-up in all-comers, particularly for patients who underwent the IVUS-defined optimal procedure, compared with those with angiography guidance.
First three authors contributed equally to the manuscript
This study was funded by the National Natural Science Foundation of China (NSFC 81970307), and was jointly supported by Six Talent Peaks Project of Jiangsu Province (2019-WSN-156), Social Development Project of Jiangsu Province (BE2019616), Jiangsu Commission of Health (H2019077), Jiangsu Provincial Special Program of Medical Science (BE2019615), Nanjing Commission of Health (ZKX19027), and Nanjing Health Youth Talent Training project (QRX17017).
- Received September 9, 2020.
- Revision received October 4, 2020.
- Accepted October 5, 2020.
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