Abstract 9349: Procedural Characteristics of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention and Their Clinical Implications

Abstract

Introduction: Despite the clinical benefits to intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI), most patients with coronary artery disease undergo angiography-guided PCI alone in real world. Hypothesis: We sought to investigate the procedural characteristics of IVUS-guided PCI and their clinical outcomes, as compared with angiography-guided PCI. Methods: This was a cohort study using patient-level data from IVUS-XPL and ULTIMATE clinical trials. A total of 2,848 patients with 3,872 native coronary lesions were included and procedural characteristics assessed by quantitative coronary angiography (QCA) were compared between IVUS and angiography guidance. Results: Stent-to-reference vessel diameter ratio (i.e., QCA stent sizing) was greater (1.11±0.16 vs 1.07±0.14, p<0.001) and high-pressure post-dilation was more frequently performed (83.7% vs 75.4%, p<0.001) with IVUS guidance, whereas residual stent edge dissections were more frequent in lesions treated with IVUS guidance (4.6% vs 0.7%, p<0.001). Given the dissection risk, optimal QCA stent sizing for IVUS guidance was a stent-to-QCA reference vessel diameter ratio ≥1.1 to <1.3. Among 1,424 patients (1,969 lesions) treated with angiography guidance, QCA stent sizing <1.0 was observed in 651 (33.1%) lesions while QCA stent sizing ≥1.1 to <1.3 was observed in only 526 (26.7%) lesions. Under angiography guidance, patients with both QCA stent sizing ≥1.1 to <1.3 and high-pressure post-dilation (235/1,424, 16.5%) had a lower risk of 3-year target lesion failure compared with others (hazard ratio=0.532, 95% confidence interval=0.293-0.966, p=0.038). Conclusions: IVUS-guided PCI resulted in larger QCA-assessed stent sizing and more frequent post-dilation with high-pressure inflations. These procedures may further improve long-term clinical outcomes in patients undergoing PCI without IVUS.