Longest Lesions Benefit Most From IVUS Guidance in PCI

Intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) is even better for longer lesions, a meta-analysis suggested.

In general, IVUS-guided PCI was tied to a reduction in major adverse coronary events compared with a angiography-led strategy over a mean of 14 months (risk ratio [RR] 0.70, 95% CI 0.58-0.85), Anthony A. Bavry, MD, MPH, of Malcolm Randall VA Medical Center in Gainesville, Fla., and colleagues reported online in the Journal of the American College of Cardiology.

But the relative advantage of IVUS was greater at extended lesion lengths, with a 19% greater difference between strategies in risk of events with every additional 10 mm (RR 0.81, 95% CI 0.66-0.98).

"The American College of Cardiology/American Heart Association 2011 revascularization guideline recommends IVUS guidance for left main coronary artery PCI and for the assessment of non-left main intermediate coronary stenosis. The results of this analysis support the recommendation to expand IVUS-guidance for PCI of longer coronary lesions (i.e., >30 mm)," Bavry's group concluded.

"We demonstrated that an IVUS-guided PCI approach is superior to an angiography-guided PCI approach in reducing the risk of major adverse cardiac events."

Bavry's group performed a pooled analysis using data from 14 trials comparing the two guidance strategies, seven each for drug-eluting stents (DES) and bare metal stents (BMS).

The advantage of IVUS was seen with both DES (RR 0.65, 95% CI 0.52-0.82) and BMS (RR 0.74, 95% CI 0.54-1.00). There was no significant interaction with lesion length, which was longer at baseline in in DES recipients (mean 32 versus 13 mm, P<0.0001).

The authors noted that they "did not comment on the impact of IVUS guidance on other outcomes because previous meta-analyses have confirmed this benefit."

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