Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions

Sung Hwan Kim, Young Hak Kim, Soo Jin Kang, Duk Woo Park, Seung Whan Lee, Cheol Whan Lee, Myeong Ki Hong, Sang Sig Cheong, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Abstract

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.

Original languageEnglish
Pages (from-to)612-618
Number of pages7
JournalAmerican Journal of Cardiology
Volume106
Issue number5
DOIs
Publication statusPublished - 2010 Sep 1

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Stents
Drug-Eluting Stents
Confidence Intervals
Thrombosis
Mortality
Proportional Hazards Models
Metals
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, S. H., Kim, Y. H., Kang, S. J., Park, D. W., Lee, S. W., Lee, C. W., ... Park, S. J. (2010). Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions. American Journal of Cardiology, 106(5), 612-618. https://doi.org/10.1016/j.amjcard.2010.04.016
Kim, Sung Hwan ; Kim, Young Hak ; Kang, Soo Jin ; Park, Duk Woo ; Lee, Seung Whan ; Lee, Cheol Whan ; Hong, Myeong Ki ; Cheong, Sang Sig ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions. In: American Journal of Cardiology. 2010 ; Vol. 106, No. 5. pp. 612-618.
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abstract = "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.",
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Kim, SH, Kim, YH, Kang, SJ, Park, DW, Lee, SW, Lee, CW, Hong, MK, Cheong, SS, Kim, JJ, Park, SW & Park, SJ 2010, 'Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions', American Journal of Cardiology, vol. 106, no. 5, pp. 612-618. https://doi.org/10.1016/j.amjcard.2010.04.016

Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions. / Kim, Sung Hwan; Kim, Young Hak; Kang, Soo Jin; Park, Duk Woo; Lee, Seung Whan; Lee, Cheol Whan; Hong, Myeong Ki; Cheong, Sang Sig; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: American Journal of Cardiology, Vol. 106, No. 5, 01.09.2010, p. 612-618.

Research output: Contribution to journalArticle

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T1 - Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions

AU - Kim, Sung Hwan

AU - Kim, Young Hak

AU - Kang, Soo Jin

AU - Park, Duk Woo

AU - Lee, Seung Whan

AU - Lee, Cheol Whan

AU - Hong, Myeong Ki

AU - Cheong, Sang Sig

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

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Y1 - 2010/9/1

N2 - 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.

AB - 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.

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