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Original Articles

Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis

Seung-Jung Park, MD, PhD^*; Young-Hak Kim, MD, PhD^*; Duk-Woo Park, MD, PhD; Seung-Whan Lee, MD, PhD; Won-Jang Kim, MD, PhD; Jon Suh, MD; Sung-Cheol Yun, PhD; Cheol Whan Lee, MD, PhD; Myeong-Ki Hong, MD, PhD; Jae-Hwan Lee, MD, PhD; Seong-Wook Park, MD, PhD for the MAIN-COMPARE Investigators

From the Department of Cardiology (S.-J.P., Y.-H.K., D.-W.P., S.-W.L., W.-J.K., J.S., C.W.L., M.-K.H., S.-W.P.), Asan Medical Center, University of Ulsan College of Medicine; Seoul, Korea; Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea; and Department of Cardiology (J.-H.L.), Chungnam National University Hospital, Daejeon, Korea.

Correspondence to Seung-Jung Park, MD, PhD, Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, South Korea 138-736. E-mail sjpark{at}amc.seoul.kr

Received June 16, 2008; accepted April 1, 2009.

Background— Although intravascular ultrasound (IVUS) guidance has been useful in stenting for unprotected left main coronary artery stenosis, its impact on long-term mortality is still unclear.

Methods and Results— In the MAIN-COMPARE registry, patients with unprotected left main coronary artery stenosis in a hemodynamically stable condition underwent elective stenting under the guidance of IVUS (756 patients) or conventional angiography (219 patients). Patients with acute myocardial infarction were excluded. The 3-year outcomes between the 2 groups were primarily compared using propensity-score matching in the entire and separate populations according to stent type. In 201 matched pairs of the overall population, there was a tendency of lower risk of 3-year morality with IVUS guidance compared with angiography guidance (6.0% versus 13.6%, log-rank P=0.063; hazard ratio, 0.54; 95% CI, 0.28 to 1.03; Cox-model P=0.061). In particular, in 145 matched pairs of patients receiving drug-eluting stent, the 3-year incidence of mortality was lower with IVUS guidance as compared with angiography guidance (4.7% versus 16.0%, log-rank P=0.048; hazard ratio, 0.39; 95% CI, 0.15 to 1.02; Cox model P=0.055). In contrast, the use of IVUS guidance did not reduce the risk of mortality in 47 matched pairs of patients receiving bare-metal stent (8.6% versus 10.8%, log-rank P=0.35; hazard ratio, 0.59; 95% CI, 0.18 to 1.91; Cox model P=0.38). The risk of myocardial infarction or target vessel revascularization was not associated with the use of IVUS guidance.

Conclusions— Elective stenting with IVUS guidance, especially in the placement of drug-eluting stent, may reduce the long-term mortality rate for unprotected left main coronary artery stenosis when compared with conventional angiography guidance.

Key Words: coronary disease • ultrasonics • imaging • stents • left main coronary artery

*Drs Park and Kim contributed equally to this article.

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Unprotected Left Main Intervention: The Light at the End of the Tunnel?

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Circ Cardiovasc Interv 2009 2: 156-158. [Extract] [Full Text] [PDF]

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				G. W. Stone and G. S. Mintz Unprotected Left Main Intervention: The Light at the End of the Tunnel? Circ Cardiovasc Interv, June 1, 2009; 2(3): 156 - 158. [Full Text] [PDF]