USA: Intravascular ultrasound (IVUS) guidance although used infrequently in PCI procedure but when used it lowers long-term mortality, repeat revascularization, and heart attack risk, suggests a recent study in the journal JACC: Cardiovascular Interventions.
In real-world the benefit of the use of IVUS for guiding percutaneous coronary intervention (PCI) procedures is uncertain. Amgad Mentias, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, and colleagues, therefore, sought to explore if IVUS use in real-world patients is associated with improved long-term outcomes of PCI.
The researchers identified Medicare patients who underwent PCI from 2009 to 2017. They then evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. Propensity score matching and inverse probability weighting were used to adjust for baseline characteristics. Patients undergoing IVUS-guided PCI were matched to non-IVUS patients in the same hospital and year in order to account for hospital effects.
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.
Key findings of the study include:
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%).
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), MI (aHR: 0.899), and repeat revascularization (aHR: 0.893).
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," concluded the authors.
The study, "Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound," is published in the journal JACC: Cardiovascular Interventions.
DOI: https://doi.org/10.1016/j.jcin.2020.04.052