Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 2010 Sep 1;106(5):612-8. doi: 10.1016/j.amjcard.2010.04.016.
Stenting for bifurcation lesions is still challenging, and the effect of intravascular ultrasound (IVUS) guidance on long-term outcomes has not been evaluated. We assessed the long-term outcomes of IVUS-guided stenting in bifurcation lesions. We evaluated 758 patients with de novo nonleft main coronary bifurcation lesions who underwent stent implantation from January 1998 to February 2006. We compared the adverse outcomes (i.e., death, stent thrombosis, and target lesion revascularization) within 4 years, after adjustment using a multivariate Cox proportional hazard model and propensity scoring. IVUS-guided stenting significantly reduced the long-term all-cause mortality (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.13 to 0.74, p = 0.008) in the total population and in the patients receiving drug-eluting stents (DESs) (HR 0.24, 95% CI 0.06 to 0.86, p = 0.03), but not in the patients receiving bare metal stents (HR 0.41, 95% CI 0.13 to 1.26, p = 0.12). IVUS-guided stenting had no effect on the rate of stent thrombosis (HR 0.48, 95% CI 0.16 to 1.43, p = 0.19) or target lesion revascularization (HR 1.47, 95% CI 0.79 to 2.71, p = 0.21). In patients receiving DESs, however, IVUS guidance reduced the development of very late stent thrombosis (0.4% vs 2.8%, p = 0.03, log-rank test). In conclusion, in patients receiving DESs, IVUS-guided stenting for treatment of bifurcation lesions significantly reduced the 4-year mortality compared to conventional angiographically guided stenting. In addition, IVUS guidance reduced the development of very late stent thrombosis in patients receiving DESs.
分叉病变的支架置入仍然具有挑战性，血管内超声（IVUS）指导对长期结果的影响尚未得到评估。我们评估了分叉病变中 IVUS 指导下支架置入的长期结果。我们评估了 1998 年 1 月至 2006 年 2 月期间接受支架植入的 758 例新发非左主干冠状动脉分叉病变患者。我们通过多变量 Cox 比例风险模型和倾向评分对 4 年内的不良结局（即死亡、支架血栓形成和靶病变血运重建）进行了比较。IVUS 指导下的支架置入术显著降低了全人群（危险比 [HR] 0.31，95%置信区间 [CI] 0.13 至 0.74，p = 0.008）和接受药物洗脱支架（DES）的患者（HR 0.24，95% CI 0.06 至 0.86，p = 0.03）的长期全因死亡率，但在接受裸金属支架（BMS）的患者中没有影响（HR 0.41，95% CI 0.13 至 1.26，p = 0.12）。IVUS 指导下的支架置入术对支架血栓形成率（HR 0.48，95% CI 0.16 至 1.43，p = 0.19）或靶病变血运重建率（HR 1.47，95% CI 0.79 至 2.71，p = 0.21）没有影响。然而，在接受 DES 的患者中，IVUS 指导降低了晚期支架血栓形成的发生（0.4%比 2.8%，p = 0.03，log-rank 检验）。总之，在接受 DES 的患者中，与常规血管造影指导下支架置入相比，分叉病变的 IVUS 指导下支架置入术显著降低了 4 年死亡率。此外，IVUS 指导降低了接受 DES 的患者中晚期支架血栓形成的发生。
