Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis

DOI Web Site 8 Citations
  • Seung-Jung Park
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Young-Hak Kim
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Duk-Woo Park
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Seung-Whan Lee
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Won-Jang Kim
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Jon Suh
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Sung-Cheol Yun
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Cheol Whan Lee
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Myeong-Ki Hong
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Jae-Hwan Lee
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.
  • Seong-Wook Park
    From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.

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<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Although intravascular ultrasound (IVUS) guidance has been useful in stenting for unprotected left main coronary artery stenosis, its impact on long-term mortality is still unclear. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> In the MAIN-COMPARE registry, patients with unprotected left main coronary artery stenosis in a hemodynamically stable condition underwent elective stenting under the guidance of IVUS (756 patients) or conventional angiography (219 patients). Patients with acute myocardial infarction were excluded. The 3-year outcomes between the 2 groups were primarily compared using propensity-score matching in the entire and separate populations according to stent type. In 201 matched pairs of the overall population, there was a tendency of lower risk of 3-year morality with IVUS guidance compared with angiography guidance (6.0% versus 13.6%, log-rank <jats:italic>P</jats:italic> =0.063; hazard ratio, 0.54; 95% CI, 0.28 to 1.03; Cox-model <jats:italic>P</jats:italic> =0.061). In particular, in 145 matched pairs of patients receiving drug-eluting stent, the 3-year incidence of mortality was lower with IVUS guidance as compared with angiography guidance (4.7% versus 16.0%, log-rank <jats:italic>P</jats:italic> =0.048; hazard ratio, 0.39; 95% CI, 0.15 to 1.02; Cox model <jats:italic>P</jats:italic> =0.055). In contrast, the use of IVUS guidance did not reduce the risk of mortality in 47 matched pairs of patients receiving bare-metal stent (8.6% versus 10.8%, log-rank <jats:italic>P</jats:italic> =0.35; hazard ratio, 0.59; 95% CI, 0.18 to 1.91; Cox model <jats:italic>P</jats:italic> =0.38). The risk of myocardial infarction or target vessel revascularization was not associated with the use of IVUS guidance. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Elective stenting with IVUS guidance, especially in the placement of drug-eluting stent, may reduce the long-term mortality rate for unprotected left main coronary artery stenosis when compared with conventional angiography guidance. </jats:p>

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