Читать книгу Interventional Cardiology - Группа авторов - Страница 226

Observational studies overall provide robust evidence of benefit for intracoronary imaging. A multicenter revascularization for unprotected left MAIN coronary arterystenosis: COMparison of Percutaneous coronary Angioplasty versus surgical Revascularization (MAIN‐COMPARE) [50] registry of LMCA interventions showed that patients treated with IVUS‐guided DES implantation had better three year survival than patients in whom IVUS was not used to guide LMCA DES implantation (4.7% vs 16.0%, p = 0.048). A pooled analysis of four Spanish registries examined the outcomes of 1670 LMCA PCI patients. By means of matching, 505 patient pairs were constructed and survival free of cardiac death, MI, and target lesion revascularization at 3 years was 88.7% in the IVUS group and 83.6% in the non‐IVUS group (p =0.04) [51].

In a single‐center analysis by Gao et al. including consecutive patients with unprotected LMCA stenosis who underwent DES implantation, unadjusted MACE rates at one year follow‐up were significantly lower in the IVUS‐guided group. These findings were consistent after propensity‐score matching, driven by a reduction in cardiac death and target vessel revascularization (TVR) [52].

In another study, using the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), both a retrospective and a propensity‐matched analysis of 2468 patients, the authors showed that at 10 years of follow‐up, IVUS guidance reduced mortality compared to angiographic guidance from 62.1 to 32.5% (HR = 0.44) overall and from 56.6 to 33.7% (HR=0.57) in propensity score‐matched patients [53].

Recently, a single‐center registry of 6005 patients assessed the impact of IVUS‐guided PCI on long‐term (64 months median follow‐up) in patients undergoing PCI for complex lesions (11.4% LMCA PCI). IVUS guidance was associated with a reduction in cardiac mortality both overall, in every patient subgroup, and in almost every lesion subgroup. Overall, IVUS‐guided DES implantation was associated with a signifcantly lower risk of cardiac death compared with angiography‐guided DES implantation (10.2% vs 16.9%; HR = 0.57, p<0.001) [54].

The largest observational study so far involved an analysis from the British Cardiovascular Intervention Society (BCIS) database. Imaging guidance (mostly IVUS) for LMCA PCI increased from 30.3% in 2007 to 50.2% in 2014. Of note, imaging guidance was associated with lower 30‐day and 12‐month all‐cause mortality rates. Operators with greater LMCA PCI volumes had greater mortality reductions when these operators used IVUS guidance [55].