Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents: The ADAPT-DES Study
Background—Prior small to modest sized studies suggest a benefit of IVUS guidance in non-complex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown.
Methods and Results—ADAPT-DES was a prospective, multicenter, non-randomized "all-comers" study of 8583 consecutive patients at 11 international centers designed to determine the frequency, timing, and correlates of stent thrombosis (ST) and adverse clinical events after DES. Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes. IVUS was utilized in 3349 (39%) patients, and larger diameter devices, longer stents, and/or higher inflation pressures were used in 74% of IVUS-guided cases. IVUS guidance compared to angiography guidance was associated with reduced 1-year rates of definite/probable ST (0.6% [18 events] versus 1.0% [53 events]; adjusted hazard radio [HR], 0.40; 95% confidence interval [CI], 0.21-0.73; P=0.003), myocardial infarction (MI) (2.5% versus 3.7%; adjusted HR, 0.66; 95% CI, 0.49-0.88; P=0.004) and composite adjudicated major adverse cardiac events (MACE: cardiac death, MI, or ST) (3.1% versus 4.7%; adjusted HR, 0.70; 95% CI, 0.55-0.88; P=0.002). The benefits of IVUS were especially evident in patients with acute coronary syndromes and complex lesions, although significant reductions in MACE were present in all patient subgroups including stable angina and single vessel disease.
Conclusions—In ADAPT-DES, the largest study of IVUS use to date, IVUS guidance was associated with a reduction in ST, MI, and MACE within 1 year following DES implantation.
Clinical Trial Registration Information—http://www.clinicaltrials.gov. Identifier: NCT00638794.
- Received May 21, 2013.
- Revision received October 17, 2013.
- Accepted October 21, 2013.