Intravascular ultrasound does not provide any significant clinical benefit for percutaneous coronary intervention of bifurcation lesions Giuseppe Biondi Zoccai University of Turin, Turin, Italy On behalf of the I-BIGIS Investigators: Giuseppe Biondi Zoccai, University of Turin, Turin, Italy; Imad Sheiban, University of Turin, Turin, Italy; Enrico Romagnoli, Policlinico Casilino, Rome, Italy; Stefano De Servi, Legnano Hospital, Legnano, Italy; Corrado Tamburino, University of Catania, Catania, Italy; Antonio Colombo, Columbus Hospital & S. Raffaele University, Milan, Italy; Gennaro Sardella, University of Rome, Rome, Italy; Pierluigi Omedè, University of Turin, Turin, Italy; Filippo Sciuto, University of Turin, Turin, Italy; Ernesto Lioy, Policlinico Casilino, Rome, Italy; Davide Capodanno, University of Catania, Catania, Italy; Giuseppe Sangiorgi, University of Modena, Modena, Italy

BACKGROUND AND AIM Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results for these lesions. We thus aimed to compare IVUS-guided PCI vs. standard PCI in a large registry of patients undergoing PCI for bifurcations in the current era.

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 choose stent size, optimize stent expansion and guide kissing inflation, routine IVUS usage is not associated with any significant clinical benefit for the percutaneous revascularization of coronary bifurcation lesions.

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