Published online before print February 20, 2009, doi: 10.1161/CIRCINTERVENTIONS.108.778647
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Original Articles |
A Randomized Controlled Trial of Angiography Versus Intravascular Ultrasound-Directed Bare-Metal Coronary Stent Placement (The AVID Trial)
From the Division of Cardiovascular Diseases (R.J.R, P.D.S., P.S.T, J.E.L., R.A.S.), Scripps Clinic, La Jolla, Calif; New York University Medical Center (M.J.A.), New York, NY; Northwestern University Feinberg School of Medicine (C.J.D.), Chicago, Ill; Comprehensive Cardiovascular Care Group (A.C.D), Milwaukee, Wis; Stanford University (P.J.F.), Palo Alto, Calif; University of Washington Medical Center (S.L.G.), Seattle, Wash; St. Vincent Hospital (J.B.H.), Indianapolis, Ind; Columbia University (M.B.L.), New York, NY; Strong Memorial Hospital of the University of Rochester (F.S.L.), Rochester, NY; Weill Medical College of Cornell University (S.C.W.), New York, NY; Cardiovascular Research Institute (N.J.W.), Washington Hospital Center, Wash, DC; and Austin Heart Hospital (D.M.Z.), Austin, Tex.
Correspondence to Robert J. Russo, MD, PhD, Division of Cardiovascular Diseases; Scripps Clinic, SW206, 10666 North Torrey Pines Road, La Jolla, CA 92037. E-mail Russo.Robert{at}ScrippsHealth.org
Received May 16, 2008; accepted February 13, 2009.
Background— AVID (Angiography Versus Intravascular ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of intravascular ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR).
Methods and Results— After elective coronary stent placement and an optimal angiographic result (<10% stenosis), 800 patients were randomized to Angiography- or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90±2.43 mm2 in the Angiography group and 7.55±2.82 mm2 in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level [CI], [–8.3% to 0.5%]). When vessels with a distal reference diameter <2.5 mm by core laboratory angiography measurement were excluded from analysis, the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the IVUS group (P=0.01, 95% CI, [–10.6% to –1.2%]). With a prestent angiographic stenosis of 
70%, the TLR rate was lower in the IVUS group compared with the Angiography group (3.1% versus 14.2%; P=0.002; 95% CI, [–18.4% to –4.2%]).
Conclusions— IVUS-directed bare-metal stent placement results in larger acute stent dimensions without an increase in complications and a significantly lower 12-month TLR rate for vessels 2.5 mm by angiography and for vessels with high-grade prestent stenosis. However, for the entire sample analyzed on an intention-to-treat basis, IVUS-directed bare-metal stent placement does not significantly reduce the 12-month TLR rate when compared with stent placement guided by angiography alone. In addition, IVUS evaluation of adequate stent expansion is underutilized by experienced operators.
Key Words: angiography • intravascular ultrasound • randomized controlled trial • restenosis • stents
CLINICAL PERSPECTIVE
The online-only Data Supplement is available at http://circinterventions.ahajournals.org/cgi/content/full/10.1161/CIRCINTERVENTIONS.108.778647/DC1.
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