Effect of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation 5-Year Follow-Up of the IVUS-XPL Randomized Trial
- Authors
- Hong, Sung-lin; Mintz, Gary S.; Ahn, Chul-Min; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Kang, Tae-Soo; Kang, Woong-Chol; Kim, Yong Hoon; Hur, Seung-Ho; Hong, Bum-Kee; Choi, Donghoon; Kwon, Hyuckmoon; Jang, Yangsoo; Hong, Myeong-Ki
- Issue Date
- 13-Jan-2020
- Publisher
- ELSEVIER SCIENCE INC
- Keywords
- coronary artery disease; drug-eluting stent; intravascular ultrasound
- Citation
- JACC-CARDIOVASCULAR INTERVENTIONS, v.13, no.1, pp.62 - 71
- Journal Title
- JACC-CARDIOVASCULAR INTERVENTIONS
- Volume
- 13
- Number
- 1
- Start Page
- 62
- End Page
- 71
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/17633
- DOI
- 10.1016/j.jcin.2019.09.033
- ISSN
- 1936-8798
- 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) (c) 2020 by the American College of Cardiology Foundation.
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