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Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial.

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Author(s)
Sung-Jin HongByeong-Keuk KimDong-Ho ShinChung-Mo NamJung-Sun KimYoung-Guk KoDonghoon ChoiTae-Soo KangWoong-Chol KangAe-Young HerYong Hoon KimSeung-Ho HurBum-Kee HongHyuckmoon KwonYangsoo JangMyeong-Ki Hong
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
JAMA: Journal of the American Medical Association.
Issued Date
2015
Volume
314
Issue
20
Abstract
IMPORTANCE Use of intravascular ultrasound (IVUS) promotes better clinical outcomes for
coronary intervention in complex coronary lesions. However, randomized data demonstrating
the clinical usefulness of IVUS are limited for lesions treated with drug-eluting stents.
OBJECTIVE To determine whether the long-term clinical outcomes with IVUS-guided
drug-eluting stent implantation are superior to those with angiography-guided implantation
in patients with long coronary lesions.
DESIGN, SETTING, AND PARTICIPANTS The Impact of Intravascular Ultrasound Guidance on
Outcomes of Xience Prime Stents in Long Lesions (IVUS-XPL) randomized, multicenter trial
was conducted in 1400 patients with long coronary lesions (implanted stent 28mmin
length) between October 2010 and July 2014 at 20 centers in Korea.
INTERVENTIONS Patients were randomly assigned to receive IVUS-guided (n = 700) or
angiography-guided (n = 700) everolimus-eluting stent implantation.
MAIN OUTCOMES AND MEASURES Primary outcome measurewas the composite of major
adverse cardiac events, including cardiac death, target lesion-relatedmyocardial infarction, or
ischemia-driven target lesion revascularization at 1 year, analyzed by intention-to-treat.
RESULTS One-year follow-up was complete in 1323 patients (94.5%). Major adverse cardiac
events at 1 year occurred in 19 patients (2.9%) undergoing IVUS-guided and in 39 patients
(5.8%) undergoing angiography-guided stent implantation (absolute difference, −2.97%
[95%CI, −5.14%to −0.79%]) (hazard ratio [HR], 0.48 [95%CI, 0.28 to 0.83], P = .007). The
difference was driven by a lower risk of ischemia-driven target lesion revascularization in
patients undergoing IVUS-guided (17 [2.5%]) compared with angiography-guided (33 [5.0%])
stent implantation (HR, 0.51 [95%CI, 0.28 to 0.91], P = .02). Cardiac death and target
lesion–relatedmyocardial infarction were not significantly different between the 2 groups.
For cardiac death, there were 3 patients (0.4%) in the IVUS-guided group and 5 patients
(0.7%) in the angiography-guided group (HR, 0.60 [95%CI, 0.14 to 2.52], P = .48). Target
lesion–relatedmyocardial infarction occurred in 1 patient (0.1%) in the angiography-guided
stent implantation group (P = .32).
CONCLUSIONS AND RELEVANCE Among patients requiring long coronary stent implantation,
the use of IVUS-guided everolimus-eluting stent implantation, compared with
angiography-guided stent implantation, resulted in a significantly lower rate of the composite
of major adverse cardiac events at 1 year. These differences were primarily due to lower risk of
target lesion revascularization.
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine
Citation
Sung-Jin Hong et al. (2015). Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA: Journal of the American Medical Association., 314(20), 2155–2163. doi: 10.1001/jama.2015.15454
Type
Article
ISSN
0098-7484
Source
https://jamanetwork.com/journals/jama/fullarticle/2469205
DOI
10.1001/jama.2015.15454
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32955
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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