Is Routine Postdilation during Angiography-Guided Stent Implantation as Good as Intravascular Ultrasound Guidance? An Analysis Using Data from IVUS-XPL and ULTIMATE

Yong Joon Lee, Jun Jie Zhang, Gary S. Mintz, Sung Jin Hong, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Jing Kan, Tao Pan, Xiaofei Gao, Zhen Ge, Shao Liang Chen, Myeong Ki Hong

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10 Citations (Scopus)

Abstract

Background: There are 2 competing approaches to optimize drug-eluting stent implantation: angiography-guided routine postdilation or intravascular ultrasound (IVUS) guidance. Methods: From the pooled data of 2 randomized trials, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), that compared IVUS- versus angiography-guided drug-eluting stent implantation, we compared 1037 patients (1265 lesions) with IVUS-guided postdilation, 905 patients (1170 lesions) with angiography-guided postdilation, and 383 patients (397 lesions) with angiography-guided drug-eluting stent implantation without postdilation as a reference group; all patients required ≥28 mm long stents. The primary end point was composite of cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 3 years. Results: Postintervention quantitative coronary angiography-based minimum lumen diameter was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (2.5±0.4 mm versus 2.5±0.4 mm; P=0.367). However, it was larger in the IVUS guidance with postdilation versus the angiography guidance without postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P=0.046), and also in the IVUS guidance with postdilation versus the angiography guidance with postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P<0.001). The rate of the primary end point was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (8.6% versus 9.8%; hazard ratio, 0.86 [95% CI, 0.58-1.29]; P=0.473). However, it was lower after IVUS guidance with postdilation versus angiography guidance without postdilation (4.5% versus 9.8%; hazard ratio, 0.44 [95% CI, 0.28-0.68]; P<0.001) and also after IVUS guidance with postdilation versus angiography guidance with postdilation (4.5% versus 8.6%; hazard ratio, 0.51 [95% CI, 0.35-0.74]; P<0.001). Conclusions: In patients undergoing long drug-eluting stent implantation, IVUS-guided postdilation was associated with improved long-term clinical outcomes, unlike angiography-guided postdilation.

Original languageEnglish
Pages (from-to)E011366
JournalCirculation: Cardiovascular Interventions
Volume15
Issue number1
DOIs
Publication statusPublished - 2022 Jan 1

Bibliographical note

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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