Comparison of one-year clinical outcomes between intravascular ultrasound-guided versus angiography-guided implantation of drug-eluting stents for left main lesions: a single-center analysis of a 1,016-patient cohort

Figures & data

Figure 1 Study flow chart.

Abbreviations: IVUS, intravascular ultrasound; ULMCA, unprotected left main coronary artery.

Table 1 Baseline clinical characteristics of the IVUS-guided and angiography-guided groups

	IVUS-guided (n=337)	Angiography-guided (n=679)	P-value
Age, years	66.0±10.4	67.1±10.0	0.098
Males, n (%)	274 (81.3)	526 (77.5)	0.159
BMI, kg/m^2	24.0±3.2	24.3±3.2	0.306
Hypertension, n (%)	244 (72.4)	489 (72.0)	0.897
Hyperlipidemia, n (%)	228 (67.7)	487 (71.7)	0.181
Diabetes, n (%)	109 (32.3)	232 (34.2)	0.562
Stroke, n (%)	14 (4.2)	26 (3.8)	0.802
Current smoker, n (%)	111 (33.1)	230 (34.1)	0.754
Chronic renal insufficiency, n (%)	88 (26.6)	214 (32.3)	0.066
eGFR, mL/min/1.73 m^2	73.3±22.3	69.2±21.6	0.005
Serum creatinine, μmol/L	84.3±24.5	90.4±41.9	0.004
Previous MI, n (%)	60 (17.9)	123 (18.1)	0.920
Acute MI, n (%)	44 (13.1)	104 (15.3)	0.336
STEMI	24 (7.1)	78 (11.5)	0.029
NSTEMI	20 (5.9)	26 (3.8)	0.129
Cardiac shock	5 (1.5)	15 (2.2)	0.431
CHF, n (%)	58 (17.2)	144 (21.2)	0.133
LVEF, %	58.7±10.1	56.7±11.7	0.011
Previous PCI, n (%)	60 (17.8)	119 (17.5)	0.913
Previous CABG, n (%)	2 (0.6)	15 (2.2)	0.069
PAD, n (%)	26 (7.7)	58 (8.5)	0.652

Abbreviations: BMI, body mass index; CABG, coronary artery bypass grafting; eGFR, estimated glomerular filtration rate; IVUS, intravascular ultrasound; MI, myocardial infarction; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-STEMI; CHF, congestive heart failure; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; PAD, peripheral artery disease.

Table 2 Lesion characteristics of the IVUS-guided and angiography-guided groups

	IVUS-guided (n=337)	Angiography-guided (n=679)	P-value
Right dominant, n (%)	318 (94.4)	644 (94.8)	0.746
Downstream lesion, n (%)
Lesion number, n, (%)	1.2±1.0	1.3±1.0	0.552
LAD	224 (66.5)	479 (70.5)	0.185
LCX	125 (37.1)	324 (47.7)	0.001
RCA	146 (43.3)	369 (54.3)	0.001
Multivessel disease	163 (48.4)	393 (57.9)	0.004
CTO lesion	55 (16.3)	216 (31.8)	<0.001
LAD	27 (8.0)	114 (16.8)	<0.001
LCX	12 (3.6)	57 (8.4)	0.004
RCA	22 (6.5)	97 (14.3)	<0.001
>1 CTO	7 (2.1)	45 (6.6)	0.002
Lesions in LM, n (%)
With ostial disease	32 (9.5)	59 (8.7)	0.672
With body disease	16 (4.7)	30 (4.4)	0.812
With whole trunk	60 (17.8)	147 (21.6)	0.152
Isolated bifurcation	191 (56.7)	359 (52.9)	0.252
LM bifurcation lesions by Medina classification, n (%)
0, 0, 1	4 (1.2)	15 (2.2)	0.257
0, 1, 0	39 (11.6)	78 (11.5)	0.968
0, 1, 1	41 (12.2)	63 (9.3)	0.153
1, 0, 0	14 (4.2)	22 (3.2)	0.458
1, 0, 1	15 (4.5)	25 (3.7)	0.553
1, 1, 0	37 (11.0)	77 (11.3)	0.864
1, 1, 1	140 (41.5)	313 (46.1)	0.169
Lesions characteristics in LM
Calcification	109 (32.3)	253 (37.3)	0.123
Needing rotablation	9 (2.7)	16 (2.4)	0.761
Restenotic	9 (2.7)	17 (2.5)	0.874
Thrombus-containing	7 (2.1)	16 (2.4)	0.778
CTO	3 (0.9)	7 (1.0)	0.831
TIMI grade 0–2	3 (0.9)	11 (1.6)	0.347
NERS score, points	23.7±12.6	27.2±13.8	<0.001
SYNTAX score, points	28.4±13.8	34.0±15.9	<0.001

Abbreviations: IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; LM, left main stem; CTO, chronic total occlusion; TIMI, Thrombolysis in Myocardial Infarction; NERS, NEw Risk Stratification; SYNTAX, SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery.

Table 3 Procedural characteristics of the IVUS-guided and angiography-guided groups

	IVUS-guided (n=337)	Angiography-guided (n=679)	P-value
Transradial, n (%)	212 (62.9)	341 (50.2)	<0.001
Urgent procedures, n (%)	19 (5.6)	56 (8.2)	0.134
Temporary pacing, n (%)	3 (0.9)	12 (1.8)	0.275
IABP, n (%)	20 (5.9)	57 (8.4)	0.163
IIb/IIIa inhibitor used, n (%)	22 (6.5)	54 (8.0)	0.416
Predilation, n (%)	145 (43.0)	371 (54.6)	<0.001
Stent in LM
Sirolimus-eluting stent, n (%)	296 (87.8)	583 (86.0)	0.120
Stent number, n	1.5±0.6	1.4±0.6	0.377
Diameter, mm	3.5±0.4	3.4±0.4	0.001
Length, mm	35.4±18.0	33.3±16.2	0.063
Two-stent techniques for LM bifurcation	154 (45.7)	280 (41.2)	0.176
DK crush	70 (45.5)	110 (39.3)	0.212
Crush (Classic crush, Mini-crush, Reverse crush)	11 (7.1)	23 (8.2)	0.691
Culotte	53 (34.4)	72 (25.7)	0.055
T stenting	13 (8.4)	56 (20.0)	0.002
V/SKS stenting	7 (4.5)	19 (6.8)	0.347
Post-dilation	321 (98.2)	543 (98.2)	1.0
Maximum balloon diameter, mm	3.8±0.5	3.6±0.5	<0.001
Ratio of balloon and stent diameter	1.1±0.1	1.1±0.1	0.033
Maximum pressure, atm	16.5±3.8	16.2±4.0	0.387
Complete revascularization, n (%)	252 (74.8)	396 (58.3)	<0.001
Final TIMI grade 3, n (%)	337 (100)	676 (99.6)	0.555
Angiographic success	336 (99.7)	635 (93.5)	<0.001

Abbreviations: IABP, intra-aortic balloon pump; IVUS, intravascular ultrasound; LM, left main stem; DK, double kissing; SKS, simultaneous kissing stents; TIMI, Thrombolysis in Myocardial Infarction.

Table 4 Clinical outcomes in the IVUS-guided and angiography-guided groups

	IVUS-guided (n=337)	Angiography-guided (n=679)	P-value
In-hospital, n (%)
Cardiac death	1 (0.3)	16 (2.4)	0.016
MI	36 (10.7)	105 (15.5)	0.038
STEMI	2 (0.6)	15 (2.2)	0.059
NSTEMI	34 (10.1)	90 (13.3)	0.147
TLR	0	7 (1.0)	0.142
CABG	0	0
TVR	1 (0.3)	13 (1.9)	0.072
MACE	37 (11.0)	115 (16.9)	0.012
Stent thrombosis	0	8 (1.2)	0.104
Definite	0	5 (0.7)	0.270
Probable	0	3 (0.4)	0.543
At one year, n (%)
Cardiac death	6 (1.8)	42 (6.2)	0.002
MI	38 (11.3)	117 (17.2)	0.013
STEMI	4 (1.2)	23 (3.4)	0.040
NSTEMI	34 (10.1)	96 (14.1)	0.069
TLR	8 (2.4)	64 (9.4)	<0.001
CABG	1 (0.3)	6 (0.9)	0.508
TVR	11 (3.3)	80 (11.8)	<0.001
MACE	50 (14.8)	188 (27.7)	<0.001
Stent thrombosis	2 (0.6)	18 (2.7)	0.026
Definite	0	9 (1.3)	0.077
Probable	0	6 (0.9)	0.195
Late	2 (0.6)	7 (1.0)	0.730

Abbreviations: IVUS, intravascular ultrasound; MI, myocardial infarction; STEMI, ST segment elevation myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; TLR, target lesion revascularization; CABG, coronary artery bypass grafting; TVR, target vessel revascularization; MACE, major adverse cardiac events.

Figure 2 Freedom from cardiac events in intravascular ultrasound guidance versus angiography guidance in the propensity score-matched population. Freedom from cardiac death (CD) (A), myocardial infarction (MI) (B), target lesion revascularization (TLR) (C), target vessel revascularization (TVR) (D), major adverse cardiac events (MACE) (E), and stent thrombosis (ST) (F) after intravascular ultrasound guidance (red line) versus angiography guidance (blue line) at one-year follow-up in the propensity score-matched population.

Table 5 Clinical outcomes after propensity score matching

	IVUS-guided (n=291)	Angiography-guided (n=291)	P-value
In-hospital, n (%)
Cardiac death	1 (0.3)	3 (1.0)	0.616
MI	35 (12.0)	39 (13.4)	0.619
STEMI	2 (0.7)	5 (1.7)	0.447
NSTEMI	33 (11.3)	34 (11.7)	0.897
TLR	0	2 (0.7)	0.479
CABG	0	0
TVR	1 (0.3)	3 (1.0)	0.616
MACE	36 (12.4)	41 (14.1)	0.541
Stent thrombosis	0	3 (1.0)	0.247
Definite	0	2 (0.7)	0.479
Probable	0	1 (0.3)	1.000
At one year, n (%)
Cardiac death	5 (1.7)	15 (5.2)	0.023
MI	36 (12.4)	44 (15.1)	0.336
STEMI	3 (1.0)	10 (3.4)	0.050
NSTEMI	33 (11.3)	35 (12.0)	0.796
TLR	8 (2.7)	24 (8.2)	0.004
CABG	1 (0.3)	1 (0.3)	1.000
TVR	10 (3.4)	29 (10.0)	0.002
MACE	47 (16.2)	71 (24.4)	0.014
Stent thrombosis	1 (0.3)	7 (2.4)	0.075
Definite	0	2 (0.7)	0.479
Probable	0	3 (1.0)	0.247
Late	1 (0.3)	2 (0.7)	1.000

Abbreviations: IVUS, intravascular ultrasound; MI, myocardial infarction; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; TLR, target lesion revascularization; CABG, coronary artery bypass grafting; TVR, target vessel revascularization; MACE, major adverse cardiac events.

Table S1 Baseline clinical, angiographic, and procedural characteristics after propensity matching

	IVUS-guided (n=291)	Angiography-guided (n=291)	P-value
Clinical variables
eGFR, mL/min/1.73 m^2	72.2±21.0	69.8±20.1	0.160
Serum creatinine, μmol/L	83.1±25.6	87.3±30.0	0.070
STEMI	26 (8.9)	28 (9.6)	0.775
LVEF, %	57.3±10.2	56.9±8.2	0.602
Angiographic variables
Downstream lesion, n (%)
LCX	107 (36.8)	117 (40.2)	0.394
RCA	141 (48.5)	152 (52.2)	0.362
Multivessel disease	143 (49.1)	155 (53.2)	0.320
CTO lesion	59 (20.3)	73 (25.1)	0.166
LAD	28 (9.6)	39 (13.4)	0.153
LCX	19 (6.5)	23 (7.9)	0.522
RCA	21 (7.2)	30 (10.3)	0.187
>1 CTO	11 (3.8)	17 (5.8)	0.245
NERS score, points	26.7±11.9	28.1±14.3	0.200
SYNTAX score, points	30.1±16.2	32.0±13.8	0.128
Procedural variables
Transradial, n (%)	166 (57.0)	157 (53.9)	0.453
Predilation, n (%)	143 (49.1)	152 (52.2)	0.456
Stent diameter in LM, mm	3.5±0.4	3.4±0.8	0.057
T stenting techniques for LM bifurcation	36 (12.3)	51 (17.5)	0.081
Maximum balloon diameter, mm	3.7±0.1	3.6±0.9	0.060
Ratio of balloon and stent diameter	1.1±0.6	1.1±0.2	1.000
Complete revascularization, n (%)	185 (63.6)	175 (60.1)	0.557
Angiographic success	283 (97.3)	281 (96.6)	0.632

Abbreviations: eGFR, estimated glomerular filtration rate; STEMI, ST-segment elevation myocardial infarction; LVEF, left ventricular ejection fraction; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; LM, left main; CTO, chronic total occlusion; TIMI, Thrombolysis in Myocardial Infarction; NERS, NEw Risk Stratification; SYNTAX, SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery.