Abstract 4211: No Long Term Clinical Benefit of IVUS Guided PCI: Results From the NHLBI Dynamic Registry
Background: Intravascular ultrasound (IVUS) during PCI is used to understand lesion morphology and to optimize stent deployment. However, there are conflicting data regarding the benefits of IVUS in randomized clinical trials. There are no US registry data examining real world clinical outcomes of patients undergoing IVUS guided PCI.
Methods: Using patients from the NHLBI Dynamic Registry Waves 1–5 (1997–2006), demographic features, angiographic data, and in-hospital and one year outcomes of patients with (n=686) and without (n=3836) IVUS guided PCI were evaluated. Only clinical sites where at least 5% of patients in each wave were evaluated with IVUS were included.
Results: Patients undergoing IVUS guided PCI were younger (62.4 vs 63.9, p=0.007), had less diabetes (25.8% vs 30.9%, p=0.008) and CHF (7.1% vs 11.1%, p=0.002), and underwent PCI more often for stable angina (30.5% vs 21.0%, p<0.001) than for acute MI (19.7% vs 27.2%, p<0.001) compared to those not undergoing IVUS. IVUS patients had fewer significant lesions (2.6 vs 3.2, p<0.001), and the treated lesion was more likely to be left main (2.2% vs 0.9%, p<0.001) or LAD (43.4% vs 36.8, p<0.001) in location. The lesions in the IVUS patients were more frequently ostial (12.1% vs 8.1%, p<0.001), previously stented (12.9% vs 7.2%, p<0.0001), calcified (47.6% vs 29.2%, p<0.001) and ulcerated (12.3% vs 9.5%, p=0.009) with a larger reference vessel size described (3.4mm vs 3.0mm, p<0.001). Procedural success was higher in IVUS stented patients (98.2% vs 96.1%, p=0.006). In-hospital and one year adjusted outcomes using a propensity analysis are shown below.
Conclusions: In this real world registry, IVUS-guided PCI was used in patients with more complex lesion anatomy. While IVUS use was associated with higher procedural success, it was not associated with a reduction in the one year need for repeat revascularization. Further study is needed to determine the mechanism responsible for an apparent higher risk of procedural MI.