3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation

• Published in: JACC. Cardiovascular interventions Vol. 14; no. 3; pp. 247 - 257
• Main Authors: Gao, Xiao-Fei, Ge, Zhen, Kong, Xiang-Quan, Kan, Jing, Han, Leng, Lu, Shu, Tian, Nai-Liang, Lin, Song, Lu, Qing-Hua, Wang, Xiao-Yan, Li, Qi-Hua, Liu, Zhi-Zhong, Chen, Yan, Qian, Xue-Song, Wang, Juan, Chai, Da-Yang, Chen, Chong-Hao, Pan, Tao, Ye, Fei, Zhang, Jun-Jie, Chen, Shao-Liang
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 08.02.2021
• Subjects: all-comers; drug-eluting stent; intravascular ultrasound; target vessel failure; intravascular ultrasound; target vessel failure; drug-eluting stent; TVF; CI; IVUS; HR; ACS; TVR; DES; PCI; all-comers; TVMI; TLR; MI
• ISSN: 1936-8798; 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2020.10.001

The aim of this study was to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance among all comers undergoing second-generation drug-eluting stent (DES) implantation. The multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions) trial showed a lower incidence of 1-year TVF after IVUS-guided DES implantation among all comers compared with angiographic guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown. A total of 1,448 all comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiographic guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk for TVF at 3 years. The safety endpoint was definite or probable stent thrombosis (ST). At 3 years, TVF occurred in 47 patients (6.6%) in the IVUS-guided group and in 76 patients (10.7%) in the angiography-guided group (p = 0.01), driven mainly by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%; p = 0.05). The rate of definite or probable ST was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure. IVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during 3-year follow-up among all comers, particularly those who underwent the IVUS-defined optimal procedure compared with those with angiographic guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions; NCT02215915) [Display omitted]