Intravascular ultrasound-guided systematic two-stent techniques for coronary bifurcation lesions and reduced late stent thrombosis

Shao Liang Chen, Fei Ye, Jun Jie Zhang, Nai Liang Tian, Zhi Zhong Liu, Teguh Santoso Sukamto, Yu Jie Zhou, Tie Ming Jiang, Shang Yu Wen, Tak W. Kwan

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)

Abstract

Background The effects of intravascular ultrasound (IVUS)-guided complex approaches using drug-eluting stents (DES) for coronary bifurcation lesions on clinical outcomes has not yet been studied in detail. Objective Our objective was to analyze the difference in 1-year outcomes following two-stent techniques involving implantation of DES for coronary bifurcation lesions between IVUS-guided and angiography-guided groups. Methods From May 26, 2007 to March 24, 2010, 628 patients received two-stent techniques (324 in the IVUS-guided group and 304 angiography-guided) and were prospectively studied. We compared major adverse cardiac events (MACE, including cardiac death, stent thrombosis [ST], myocardial infarction [MI] and target lesion/vessel revascularization) at 12-months follow-up, before and after adjusting for propensity score matching. Results At 12-months after the indexed procedure, patients in the angiography-guided group had significantly increased in-stent restenosis. Compared to the angiography-guided group, the IVUS-guided group had a significantly lower overall unadjusted ST rate (1.2% vs. 6.9%, P < 0.001), definite ST (0.6% vs. 5.3%, P < 0.001), late ST (0.6% vs. 4.3%, P = 0.003), MI (4.6% vs. 8.9%, P = 0.038) and cardiac death (0.9% vs. 3.3%, P = 0.049). By propensity score matching, 123 paired patients were matched. The late ST at 12-months follow-up was 0% in the IVUS-guided group versus 4.9% in the angiography-guided group (P = 0.029), resulting in significant differences in ST-elevation MI between the two groups (2.4% vs. 9.8%, P = 0.030). Conclusions The IVUS-guided two-stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST-elevation MI.

Original languageEnglish
Pages (from-to)456-463
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume81
Issue number3
DOIs
Publication statusPublished - 1 Feb 2013

Keywords

  • coronary bifurcation lesions
  • intravascular ultrasound
  • stent thrombosis
  • two-stent technique

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