Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention with drug-eluting stents: five-year outcomes from the CREDO-Kyoto PCI/CABG registry.

Abstract

We sought to investigate the clinical impact of intravascular ultrasound (IVUS) use in first-generation drug-eluting stent (DES) implantation as compared with angiography guidance only. From the CREDO-Kyoto registry cohort-2, the current study population consisted of 4,768 patients treated with first-generation DES only without acute myocardial infarction (AMI) at enrolment. As a retrospective cohort study, we compared clinical outcomes between the two groups of patients with or without IVUS use during the procedure (IVUS group: N=2,768, angiography group: N=2,000). The outcome measures were target vessel revascularisation (TVR), target lesion revascularisation (TLR), all-cause death, myocardial infarction, stent thrombosis, and major adverse cardiovascular events. There was no significant difference between the groups in the cumulative incidence of TVR (21.5% vs. 22.2%, p=0.57). Even after adjusting the confounders, the risk of IVUS use relative to angiography guidance for TVR remained neutral (HR: 1.09, 95% CI: 0.90-1.32, p=0.37). IVUS-guided PCI as compared with angiography-guided PCI was not associated with a lower risk of TVR in non-AMI patients treated with first-generation DES.