Published Online
on April 21, 2009

A more recent version of this article appeared on June 1, 2009

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Original Article

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

Seung-Jung Park^1,4; Young-Hak Kim¹; Duk-Woo Park¹; Seung-Whan Lee¹; Won-Jang Kim¹; Jon Suh¹; Sung-Cheol Yun²; Cheol Whan Lee¹; Myeong-Ki Hong¹; Jae-Hwan Lee³ and Seong-Wook Park¹

¹ Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;
² Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea;
³ Chungnam National University Hospital, Daejeon, Korea

⁴ E-mail: sjpark{at}amc.seoul.kr

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

Methods and Results—In the MAIN-COMPARE registry, patients with unprotected LMCA 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 two groups were primarily compared using the propensity-score matching in the entire and separate populations according to the stent type. In 201 matched pairs of overall population, there was a tendency of lower risk of 3-year morality with IVUS-guidance compared with angiography-guidance (6.0% vs. 13.6%, log-rank p=0.063; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.28-1.03; 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% vs. 16.0%, log-rank p=0.048; HR, 0.39; 95% CI, 0.15-1.02; 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% vs. 10.8%, log-rank p=0.35; HR, 0.59; 95% CI, 0.18-1.91; Cox model p=0.38). The risk of myocardial infarction or target vessel revascularization was not associated with use of IVUS-guidance.

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

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

Author contributions: For the MAIN-COMPARE Investigators. Drs SJ Park and YH Kim contributed equally to this article.

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

Gregg W. Stone and Gary S. Mintz
Circ Cardiovasc Interv 2009 2: 156-158. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				F. Alfonso, J. Dutary, and B. Zakhem Letter by Alfonso et al Regarding Article, "Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis" Circ Cardiovasc Interv, October 1, 2009; 2(5): e3 - e3. [Full Text] [PDF]

				S.-J. Park, Y.-H. Kim, and S.-J. Kang Response to Letter Regarding Article, "Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis" Circ Cardiovasc Interv, October 1, 2009; 2(5): e4 - e4. [Full Text] [PDF]

				A. Maehara, G. S. Mintz, and N. J. Weissman Advances in Intravascular Imaging Circ Cardiovasc Interv, October 1, 2009; 2(5): 482 - 490. [Full Text] [PDF]

				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]