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Impact of intravascular ultrasound on the long‐term clinical outcomes in the treatment of coronary ostial lesions
Author(s) -
Patel Yogesh,
Depta Jeremiah P.,
Patel Jayendrakumar S.,
Masrani Shriti K.,
Novak Eric,
Zajarias Alan,
Kurz Howard I.,
Lasala John M.,
Bach Richard G.,
Singh Jasvindar
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25034
Subject(s) - medicine , conventional pci , intravascular ultrasound , percutaneous coronary intervention , cardiology , myocardial infarction , revascularization , circumflex , lesion , surgery , artery
Objectives To 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). Background A higher rate of adverse cardiac events is associated with PCI of ostial lesions as compared with nonostial disease. Methods From 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 4.2 ± 2.5 years were compared between patients undergoing PCI of an ostial lesion with and without use of IVUS using univariate and propensity score adjusted analyses. Results Aorto‐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). Conclusions PCI of coronary ostial lesions with the use of IVUS was associated with significantly lower rates of adverse cardiac events.© 2015 Wiley Periodicals, Inc.