Is there any role for intravascular ultrasound in bifurcation lesions? Giuseppe Biondi-Zoccai, MD University of Turin, Turin, Italy

MODERN APPROACH TO CORONARY BIFURCATIONS Suarez de Lezo et al, TCT 2009

ROLE OF IVUS IN BIFURCATIONS Suarez de Lezo et al, TCT 2009

HISTORICAL EVIDENCE OF IMPACT OF IVUS ON PALMAZ-SCHATZ IMPLANTATION

Albiero et al, Circulation 1997

EVIDENCE FROM RANDOMIZED TRIALS: THE BMS ERA

ANY IMPACT OF IVUS ON LEFT MAIN

Agostoni et al, Am J Cardiol 2005

WHY IVUS MIGHT BE BENEFICIAL

Hassan et al, Eur Heart J 2010

IVUS MIGHT PREVENT STENT THROMBOSIS

Roy et al, Eur Heart J 2008

CAN IVUS REDUCE DEATH AND STENT THROMBOSIS BUT NOT TLR?

Kim et al, Am J Cardiol 2010

CAN IVUS REDUCE DEATH AND STENT THROMBOSIS BUT NOT TLR?

Park et al, Circ Cardiovasc Intervent 2009

OUR OWN EXPERIENCE Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4314-patient registry On behalf of the I-BIGIS Investigators BACKGROUND: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. OBJECTIVE: We aimed to compare IVUS-guided PCI vs. standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug- eluting stent era. METHODS: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long- term rate of major adverse cardiac events (MACE, i.e. death, MI or target lesion revascularization [TLR]).

OUR OWN EXPERIENCE Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4314-patient registry On behalf of the I-BIGIS Investigators RESULTS: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. 30-day outcomes were similar, with MACE in 1.3% vs. 2.1%, death in 0.9% vs. 1.0%, and stent thrombosis in 0 vs. 0.6% (all p>0.05). After 24±15 months, MACE were 17.7% vs. 16.4%, with death in 2.7% vs 4.9%, MI in 4.4% vs. 3.7%, TLR in 15.0% vs. 12.3%, and stent thrombosis in 3.1% vs. 2.7% (all p>0.05). Even at multivariable analysis with propensity score, IVUS was not associated with MACE, death, MI, TLR, or stent thrombosis (all p>0.05). CONCLUSIONS: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions is not associated with any significant clinical benefit.

METHODS A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and January 2006 at 22 Italian centers. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e. death, myocardial infarction or target lesion revascularization [TLR]).

RESULTS A total of 4314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4088 (94.8%) treated with standard PCI. Early (30-day) outcomes were similar in the 2 groups, with MACE in 1.3% vs. 2.1%, respectively, death in 0.9% vs. 1.0%, and stent thrombosis in 0 vs. 0.6% (all p>0.05).

RESULTS After an average follow-up of 24±15 months, unadjusted rates of MACE were 17.7% vs. 16.4%, with death in 2.7% vs 4.9%, myocardial infarction in 4.4% vs. 3.7%, TLR in 15.0% vs. 12.3%, and stent thrombosis in 3.1% vs. 2.7% (all p>0.05). Even at extensive multivariable analysis with propensity adjustment, IVUS guidance was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p>0.05).

BASELINE PATIENT CHARACTERISTICS

PROCEDURAL CHARACTERISTICS

30-DAY AND LONG-TERM OUTCOMES

MULTIVARIABLE OUTCOME PREDICTORS

CONCLUSIONS Despite a sound rationale to define revascularization strategy, choose stent size, optimize stent expansion and guide kissing inflation, the role of routine IVUS for coronary bifurcation lesions is still unclear

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