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Effect of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation: 5-Year Follow-Up of the IVUS-XPL Randomized Trial

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Author(s)
Sung-Jin HongGary S. MintzChul-Min AhnJung-Sun KimByeong-Keuk KimYoung-Guk KoTae-Soo KangWoong-Chol KangYong Hoon KimSeung-Ho HurBum-Kee HongDonghoon ChoiHyuckmoon KwonYangsoo JangMyeong-Ki Hong
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC: Cardiovascular Interventions
Issued Date
2020
Volume
13
Issue
1
Keyword
coronary artery diseasedrug-eluting stentintravascular ultrasound
Abstract
Objectives:
The goal of this study was to evaluate whether the beneficial effect of use of intravascular ultrasound (IVUS) is sustained for long-term follow-up.

Background:
The use of IVUS promoted favorable 1-year clinical outcome in the IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) trial. It is not known, however, whether this effect is sustained for long-term follow-up.

Methods:
The IVUS-XPL trial randomized 1,400 patients with long coronary lesions (implanted stent length ≥28 mm) to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation. Five-year clinical outcomes were investigated in patients who completed the original trial. The primary outcome was the composite of major adverse cardiac events, including cardiac death, target lesion–related myocardial infarction, or ischemia-driven target lesion revascularization at 5 years, analyzed by intention-to-treat.

Results:
Five-year follow-up was completed in 1,183 patients (85%). Major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS guidance and in 70 patients (10.7%) receiving angiographic guidance (hazard ratio: 0.50; 95% confidence interval: 0.34 to 0.75; p = 0.001). The difference was driven mainly by a lower risk for target lesion revascularization (31 [4.8%] vs. 55 [8.4%]; hazard ratio: 0.54; 95% confidence interval: 0.33 to 0.89; p = 0.007). By landmark analysis, major adverse cardiac events between 1 and 5 years occurred in 17 patients (2.8%) receiving IVUS guidance and in 31 patients (5.2%) receiving angiographic guidance (hazard ratio: 0.53; 95% confidence interval: 0.29 to 0.95; p = 0.031).

Conclusions:
Compared with angiography-guided stent implantation, IVUS-guided stent implantation resulted in a significantly lower rate of major adverse cardiac events up to 5 years. Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years post-implantation. (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions [IVUS-XPL Study]: Retrospective and Prospective Follow-Up Study; NCT03866486)
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Citation
Sung-Jin Hong et al. (2020). Effect of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation: 5-Year Follow-Up of the IVUS-XPL Randomized Trial. JACC: Cardiovascular Interventions, 13(1), 62–71. doi: 10.1016/j.jcin.2019.09.033
Type
Article
ISSN
1936-8798
Source
https://www.sciencedirect.com/science/article/pii/S1936879819320199
DOI
10.1016/j.jcin.2019.09.033
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/42737
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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