Long-term outcomes of IVUS-guided and angiography-guided drug-eluting stent implantation for left main coronary artery disease: a retrospective consort study

• Published in: Journal of cardiothoracic surgery Vol. 19; no. 1; pp. 407 - 8
• Main Authors: Yang, Qing, Ma, Xiaoyi, Wang, Yuexi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.07.2024; BioMed Central; BMC
• Subjects: Adverse cardiac events; Aged; Angiography; Blood vessels; Cardiovascular disease; Clopidogrel; Comparative analysis; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary heart disease; Death; Diseases; Drug delivery; Drug-eluting stent; Drug-Eluting Stents; Female; Health aspects; Heart; Heart diseases; Humans; Implantation; Implants; Intravascular ultrasound; Left main coronary artery; Male; Medical imaging; Medical research; Medicine, Experimental; Middle Aged; Minimum stent diameter; Mortality; Myocardial infarction; Patients; Percutaneous Coronary Intervention - methods; Prognosis; Regression analysis; Restenosis; Retrospective Studies; Stent (Surgery); Stents; Surgical implants; Treatment Outcome; Ultrasonography, Interventional - methods; Ultrasound imaging; Unprotected left main coronary artery disease; Mongolia; Minimum stent diameter; Left main coronary artery; Intravascular ultrasound; Adverse cardiac events; Drug-eluting stent; Unprotected left main coronary artery disease
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-02800-0

In patients with unprotected left main coronary artery disease (ULMCAD), this study compared the long-term prognosis of drug-eluting stent insertion guided by intravascular ultrasonography (IVUS) vs. angiography. This retrospective consort investigation was performed in December 2021. This analysis included 199 patients who underwent IVUS-guided (IVUS group, n = 81) or angiography-guided (angiography group, n = 118) drug-eluting stent implantation at the Affiliated Hospital of Inner Mongolia Medical University between September 2013 and September 2018. Major adverse cardiac events (MACE) were defined as cardiovascular death, sudden cardiac death, myocardial infarction. The IVUS group had considerably lower proportions of MACE within 1 year postoperatively (P = 0.002) and cardiac mortality within 3 years postoperatively (P = 0.018) compared to the angiography group. However, after adjusting for confounding variables, the hazard ratio for 3-year cardiac mortality was similar between the two groups (P = 0.28). In the IVUS group, there was considerably greater minimum lumen diameter (MLD) (P = 0.046), and reduced frequencies of target vessel restenosis (P < 0.050) and myocardial infarction (MI) (P = 0.024) compared to the angiography group. Cox regression analysis for 3-year cardiac mortality found that MSD was independently associated with low cardiac mortality (HR = 0.1, 95% CI: 0.01-14.92, P = 0.030). IVUS-guided drug-eluting stent implantation may lead to better long-term prognosis in patients with ULMCAD, and MSD may be a predictor for lower cardiac mortality.