Impact of intravascular ultrasound on the long-term clinical outcomes in the treatment of coronary ostial lesions

ObjectivesTo evaluate the long-term outcomes of patients with ostial lesions who underwent percutaneous coronary intervention (PCI) with and without the use of intravascular ultrasound (IVUS). BackgroundA higher rate of adverse cardiac events is associated with PCI of ostial lesions as compared with nonostial disease. MethodsFrom 7/2002 to 8/2010, 225 patients with 233 coronary ostial lesions underwent PCI with (n=82) and without (n=143) IVUS guidance. Ostial lesions included both native aorto-ostial or major coronary vessel (left anterior descending, left circumflex, and ramus intermedius) lesions. Clinical outcomes [cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR)] at a mean follow-up of 4.22.5 years were compared between patients undergoing PCI of an ostial lesion with and without use of IVUS using univariate and propensity score adjusted analyses. ResultsAorto-ostial lesions (n=109) comprised 47% of lesions, whereas the remaining lesions (53%) involved major coronary vessels. After propensity score adjustment, IVUS use was associated with lower rates of the composite of cardiovascular death, MI, or TLR (HR 0.54, 95% CI 0.29-0.99; P=0.04), composite MI or TLR (HR 0.39, 95% CI 0.18-0.83; P=0.01), and MI (HR 0.31, 95% CI 0.11-0.85; P=0.02) as compared with no IVUS. The use of IVUS was also associated with a trend towards a lower rate of TLR (HR 0.42, 95% CI 0.17-1.02; P=0.06). ConclusionsPCI of coronary ostial lesions with the use of IVUS was associated with significantly lower rates of adverse cardiac events.(c) 2015 Wiley Periodicals, Inc.