Abstract 1714: Does Intravascular Ultrasound Guidance During Percutaneous Coronary Intervention Prevent Stent Thrombosis After Implantation of Drug-Eluting Stents?
Background: Stent thrombosis (ST) can be caused by under-deployment and malapposition of the stent to the vessel wall. Routine use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) may optimize stent deployment. This study aimed to assess the impact of IVUS guidance on ST following drug-eluting stent (DES) implantation.
Methods: A cohort of 884 patients who underwent IVUS guided DES implantation to all treated lesions from April 2003 to May 2006 was identified and compared with 884 propensity matched patients who underwent DES implantation during the same period without IVUS guidance. The primary endpoint of the study was definite ST (angiographically or autopsy proven) at 12 months. Secondary endpoints were major adverse cardiac events (MACE) and its comprising endpoints.
Results: Patients were well matched for baseline clinical and angiographic characteristics. Patients who underwent IVUS guided PCI had significantly greater rotational atherectomy use, less primary stenting and more post-dilation. Dual antiplatelet therapy compliance was comparable in patients presenting with ST (P=1.0). At 12 months IVUS guidance was associated with a significant reduction in definite ST (0.7% vs.2.0% P=0.014), driven mainly by a reduction in cumulative ST at 30 days (p=0.045). However, IVUS did not significantly impact other secondary endpoints such as death and revascularization rates.
Conclusions: IVUS guided PCI is associated with a significant reduction in definite ST up to 1 year from DES implantation and should be considered for routine use in selected cases to prevent ST in the DES era.