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Multicenter Study
. 2025 Sep 12;11(6):747-755.
doi: 10.1093/ehjqcco/qcae091.

Impact of intravascular ultrasound for coronary bifurcations treated with last-generation stents: insights from the ULTRA-BIFURCAT registry

Francesco Bruno  1 , Ki Hong Choi  2 , Ovidio De Filippo  1 , Hyun Kuk Kim  3 , Mattia Doronzo  4 , Yun-Kyeong Cho  5 , Tineke H Pinxterhuis  6 , Jeehoon Kang  7 , Alessio Mattesini  8 , Young Bin Song  2 , Raffaele Piccolo  9 , Bon-Kwon Koo  7 , Wojciech Wańha  10 , Hyun-Jong Lee  11 , Bernardo Cortese  12 , Hyeon-Cheol Gwon  2 , Leor Perl  13 , Hyo-Soo Kim  7 , Domenico Tuttolomondo  14 , Mario Iannaccone  15 , Woo Jung Chun  16 , Davide Capodanno  17 , Attilio Leone  9 , Alessandra Truffa Giachet  18 , Seung-Ho Hur  5 , Giulio Stefanini  19   20 , Seung Hwan Han  21 , Javier Escaned  22 , Antonino Carmeci  1 , Gianluca Campo  23 , Giuseppe Patti  24 , Clemens von Birgelen  6 , Gaetano Maria de Ferrari  1   4 , Chang-Wook Nam  5 , Fabrizio D'Ascenzo  1   4
Affiliations
Multicenter Study

Impact of intravascular ultrasound for coronary bifurcations treated with last-generation stents: insights from the ULTRA-BIFURCAT registry

Francesco Bruno et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Background: Bifurcation lesions are associated with higher rates of major adverse cardiac events (MACE).

Aim: To investigate the impact of imaging-guided percutaneous coronary intervention (PCI) in a real-world population with coronary bifurcation lesions.

Methods and results: From the ULTRA-BIFURCAT registry, we compared intravascular ultrasound (IVUS) vs. angiographic guidance in a cohort of 3486 propensity matched patients. MACE, a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization, and stent thrombosis was the primary endpoint. Subgroup analyses were performed for unprotected left main (ULM) and non-ULM disease. PSM generated 1743 pairs. MACE occurred in 154 (9%) patients in the IVUS-guided group and in 199 (11%) patients in the angio-guided group (P = 0.09). IVUS guidance was associated with lower MACE in the ULM population [hazard ratio (HR) 0.62, 95% confidence internal (CI) 0.46-0.83], but had no impact in the non-ULM population (HR 1.12, 95% CI 0.83-1.51), P for interaction = 0.006. IVUS was associated with a reduction in all-MI (HR 0.32, 95% CI 0.16-0.64) in the ULM population and with lower stent thrombosis (ST) in the non-ULM population (HR 0.24, 95% CI 0.08-0.71). Provisional stenting was associated with lower MACE in the ULM population (HR 0.67, 95% CI 0.45-0.98), whereas kissing balloon (HR 0.75, 95% CI 0.56-0.99) and ultra-thin stents (HR 0.44, 95% CI 0.29-0.67) were protective factors in the non-ULM population.

Conclusion: In a real-world scenario, IVUS guidance during drug eluting stent (DES) implantation is associated with a lower rate of MACE in patients with ULM coronary bifurcation lesions. In non-ULM bifurcations, no difference was observed on MACE, while IVUS guidance was associated with a lower rate of ST.

Keywords: Bifurcation; Intravascular imaging; Left main coronary artery; Percutaneous coronary intervention; Prognosis.

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