Watanabe Hiroki, Morimoto Takeshi, Shiomi Hiroki, Furukawa Yutaka, Nakagawa Yoshihisa, Ando Kenji, Kadota Kazushige, Kimura Takeshi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Division of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
AsiaIntervention. 2018 Feb 20;4(1):26-33. doi: 10.4244/AIJ-D-17-00003. eCollection 2018 Feb.
We sought to investigate the clinical impact of intravascular ultrasound (IVUS) use in first-generation drug-eluting stent (DES) implantation as compared with angiography guidance only.
From the CREDO-Kyoto registry cohort-2, the current study population consisted of 4,768 patients treated with first-generation DES only without acute myocardial infarction (AMI) at enrolment. As a retrospective cohort study, we compared clinical outcomes between the two groups of patients with or without IVUS use during the procedure (IVUS group: N=2,768, angiography group: N=2,000). The outcome measures were target vessel revascularisation (TVR), target lesion revascularisation (TLR), all-cause death, myocardial infarction, stent thrombosis, and major adverse cardiovascular events. There was no significant difference between the groups in the cumulative incidence of TVR (21.5% vs. 22.2%, p=0.57). Even after adjusting the confounders, the risk of IVUS use relative to angiography guidance for TVR remained neutral (HR: 1.09, 95% CI: 0.90-1.32, p=0.37).
IVUS-guided PCI as compared with angiography-guided PCI was not associated with a lower risk of TVR in non-AMI patients treated with first-generation DES.
我们试图研究与仅采用血管造影引导相比，血管内超声（IVUS）在第一代药物洗脱支架（DES）植入中的临床影响。
从CREDO - 京都注册队列2中，当前研究人群包括4768例仅接受第一代DES治疗且入组时无急性心肌梗死（AMI）的患者。作为一项回顾性队列研究，我们比较了手术过程中使用或未使用IVUS的两组患者的临床结局（IVUS组：N = 2768，血管造影组：N = 2000）。结局指标包括靶血管血运重建（TVR）、靶病变血运重建（TLR）、全因死亡、心肌梗死、支架血栓形成以及主要不良心血管事件。两组在TVR的累积发生率上无显著差异（21.5%对22.2%，p = 0.57）。即使在调整混杂因素后，与血管造影引导相比，使用IVUS进行TVR的风险仍无差异（HR：1.09，95%CI：0.90 - 1.32，p = 0.37）。
在接受第一代DES治疗的非AMI患者中，与血管造影引导的PCI相比，IVUS引导的PCI与较低的TVR风险无关。
