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Usefulness of Intravascular Ultrasound Guidance in Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents for Chronic Total Occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry)

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Author(s)
허승호
Alternative Author(s)
Hur, Seung Ho
Publication Year
2014
Abstract
Despite the usefulness of intravascular ultrasound (IVUS) in percutaneous coronary intervention
(PCI), the impact of IVUS guidance on clinical outcomes, particularly for chronic total
occlusion (CTO) intervention, has rarely been studied. We sought to investigate the clinical
usefulness of IVUS-guided CTO intervention with second-generation drug-eluting stent
implantation. From 2007 to 2009, a total of 2,568 patients were enrolled in the Korean-CTO
registry and 534 patients with successful implantation of second-generation drug-eluting
stents were analyzed. IVUS-guided PCI was performed on 206 patients (39%). Clinical outcomes
at 2 years were compared between the IVUS-guidance group and the angiographyguidance
group in 201 propensity scoreematched pairs. The primary end point was the
occurrence of definite or probable stent thrombosis. Clinical characteristics were similar between
both groups after matching. At 2 years, the IVUS-guidance group showed significantly
less stent thrombosis than the angiography-guidance group (0% vs 3.0%, p [ 0.014) and a
lesser trend toward myocardial infarction (1.0% vs 4.0%, p [ 0.058). Target lesion revascularization
(TLR) and major adverse cardiovascular event rates were similar. However, a significant
interaction was observed between the use of IVUS and lesion length for predicting the
TLR (p[0.037), suggesting usefulness of IVUS in long-lesion (‡3 cm) relative to short-lesion
CTO. In conclusion, although IVUS-guided CTO PCI was not associated with a reduction in
overall major adverse cardiovascular events, IVUS guidance appears to be associated with a
reduction of stent thrombosis and myocardial infarction compared with angiography-guided
CTO PCI. Additionally, TLR occurred less frequently in the IVUS-guidance group, especially
for long lesions. 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;114:534e540)
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine
Citation
American Journal of Cardiology, Vol.114(4) : 534-540, 2014
Type
Article
ISSN
0002-9149
DOI
10.1016/j.amjcard.2014.05.027
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34901
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