Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, Iowa.
JACC Cardiovasc Interv. 2020 Aug 24;13(16):1880-1890. doi: 10.1016/j.jcin.2020.04.052.
This study sought to explore if intravascular ultrasound (IVUS) use in real-world patients is associated with improved long-term outcomes of percutaneous coronary intervention (PCI).
The benefit of IVUS use with PCI in real world is uncertain.
We identified Medicare patients who underwent PCI from 2009 to 2017 and evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. We used propensity score matching and inverse probability weighting to adjust for baseline characteristics. To account for hospital effects, patients undergoing IVUS-guided PCI were matched to non-IVUS patients in the same hospital and year. Sensitivity analyses comparing outcomes with and without IVUS in stable coronary artery disease and acute coronary syndrome, PCI with bare-metal stents and drug-eluting stents, complex and noncomplex PCI, and facilities with 1% to 5%, 5% to 10%, and >10% IVUS use were performed.
Overall, IVUS was used in 5.6% of all PCI patients (105,787 out of 1,877,177 patients). Patients with IVUS-guided PCI had a higher prevalence of most comorbidities. In the propensity matched analysis, IVUS-guided PCI was associated with lower 1-year mortality (11.5% vs. 12.3%), MI (4.9% vs. 5.2%), and repeat revascularization (6.1% vs. 6.7%) (p < 0.001 for all). In inverse probability weighting analysis with a median follow-up of 3.7 years (interquartile range: 1.7 to 6.4 years), IVUS-guided PCI was associated with a lower risk of mortality (adjusted hazard ratio [aHR]: 0.903; 95% confidence interval [CI]: 0.885 to 0.922), MI (aHR: 0.899; 95% CI: 0.893 to 0.904), and repeat revascularization (aHR: 0.893; 95% CI: 0.887 to 0.898) (p < 0.001 for all). These findings were consistent in all subgroups in sensitivity analyses.
In this contemporary U.S. Medicare cohort, the use of IVUS guidance in PCI remains low. Use of IVUS is associated with lower long-term mortality, MI, and repeat revascularization.
本研究旨在探讨血管内超声（IVUS）在真实世界患者中的应用是否与经皮冠状动脉介入治疗（PCI）的长期预后改善相关。
IVUS 在真实世界中联合 PCI 的获益尚不确定。
我们确定了 2009 年至 2017 年间接受 PCI 的医疗保险患者，并评估了 IVUS 应用与长期死亡率、心肌梗死（MI）和再次血运重建风险之间的关系。我们使用倾向评分匹配和逆概率加权法调整基线特征。为了考虑医院效应，在同一医院和年份，对接受 IVUS 指导的 PCI 患者进行了与非 IVUS 患者的匹配。在稳定性冠状动脉疾病和急性冠状动脉综合征、裸金属支架和药物洗脱支架的 PCI、复杂和非复杂 PCI 以及 IVUS 使用率为 1%5%、5%10%和>10%的设施中，进行了比较 IVUS 与无 IVUS 治疗的结局的敏感性分析。
总体而言，IVUS 在所有 PCI 患者中的使用率为 5.6%（1877177 例患者中有 105787 例）。接受 IVUS 指导 PCI 的患者更常见大多数合并症。在倾向评分匹配分析中，IVUS 指导 PCI 与 1 年死亡率（11.5% vs. 12.3%）、MI（4.9% vs. 5.2%）和再次血运重建（6.1% vs. 6.7%）较低相关（均<0.001）。在中位随访 3.7 年（四分位距：1.76.4 年）的逆概率加权分析中，IVUS 指导 PCI 与死亡率降低相关（校正后的危险比[aHR]：0.903；95%置信区间[CI]：0.8850.922）、MI（aHR：0.899；95%CI：0.8930.904）和再次血运重建（aHR：0.893；95%CI：0.8870.898）相关（均<0.001）。在所有亚组的敏感性分析中，这些发现均一致。
在这项美国当代医疗保险队列研究中，PCI 中 IVUS 的使用仍然较低。IVUS 的使用与较低的长期死亡率、MI 和再次血运重建相关。
