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Observational Study
. 2020 Aug 24;13(16):1880-1890.
doi: 10.1016/j.jcin.2020.04.052.

Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound

Amgad Mentias  1 , Mary Vaughan Sarrazin  2 , Marwan Saad  3 , Sidakpal Panaich  4 , Samir Kapadia  5 , Phillip A Horwitz  4 , Saket Girotra  4
Affiliations
Observational Study

Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound

Amgad Mentias et al. JACC Cardiovasc Interv. .

Abstract

Objectives: This study sought to explore if intravascular ultrasound (IVUS) use in real-world patients is associated with improved long-term outcomes of percutaneous coronary intervention (PCI).

Background: The benefit of IVUS use with PCI in real world is uncertain.

Methods: We identified Medicare patients who underwent PCI from 2009 to 2017 and evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. We used propensity score matching and inverse probability weighting to adjust for baseline characteristics. To account for hospital effects, patients undergoing IVUS-guided PCI were matched to non-IVUS patients in the same hospital and year. Sensitivity analyses comparing outcomes with and without IVUS in stable coronary artery disease and acute coronary syndrome, PCI with bare-metal stents and drug-eluting stents, complex and noncomplex PCI, and facilities with 1% to 5%, 5% to 10%, and >10% IVUS use were performed.

Results: Overall, IVUS was used in 5.6% of all PCI patients (105,787 out of 1,877,177 patients). Patients with IVUS-guided PCI had a higher prevalence of most comorbidities. In the propensity matched analysis, IVUS-guided PCI was associated with lower 1-year mortality (11.5% vs. 12.3%), MI (4.9% vs. 5.2%), and repeat revascularization (6.1% vs. 6.7%) (p < 0.001 for all). In inverse probability weighting analysis with a median follow-up of 3.7 years (interquartile range: 1.7 to 6.4 years), IVUS-guided PCI was associated with a lower risk of mortality (adjusted hazard ratio [aHR]: 0.903; 95% confidence interval [CI]: 0.885 to 0.922), MI (aHR: 0.899; 95% CI: 0.893 to 0.904), and repeat revascularization (aHR: 0.893; 95% CI: 0.887 to 0.898) (p < 0.001 for all). These findings were consistent in all subgroups in sensitivity analyses.

Conclusions: In this contemporary U.S. Medicare cohort, the use of IVUS guidance in PCI remains low. Use of IVUS is associated with lower long-term mortality, MI, and repeat revascularization.

Keywords: intravascular ultrasound; mortality; myocardial infarction; percutaneous coronary intervention.

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Figures

Figure 1A–C:
Figure 1A–C:
Kaplan Meier curves for the study outcomes A) all-cause mortality, B) myocardial infarction, C) repeat revascularization between PCI with and without intravascular ultrasound in patients presenting with acute coronary syndrome.
Figure 2:
Figure 2:
Risk estimates in key patient subgroups and interaction analysis.
Central illustration:
Central illustration:. Trends, variability and outcomes of IVUS use in PCI.
Panel A: Trend in intravascular ultrasound (IVUS) use as a percentage out of all percutaneous coronary interventions in Medicare patients in the study period. Panel B: Variability in IVUS utilization across US hospitals. Panel C-E: Kaplan Meier curves for all-cause mortality, myocardial infarction and revascularization between PCI with and without intravascular ultrasound in the overall cohort.
See this image and copyright information in PMC

Comment in

References

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