IVUS guiding optimize the outcome of intervention of coronary atherosclerotic stenotic lesions proximal to myocardial bridge.
This study aimed to evaluate the advantage of intravascular ultrasound (IVUS) in optimizing the outcome of stent implantation for stenosis proximal to myocardial bridge (MB).
A total of 117 patients with stenosis proximal to MB were randomly divided into angiography guided stent implantation (AGSI, n = 61) group and IVUS guided stent implantation (IGST n = 56). Major adverse cardiac events (MACE) were followed up to 12 months. Coronary angiography and IVUS were performed at 12 months follow up. Lumen diameter, cross section area and lumen loss was calculated. We constructed Kaplan-Meier curves to compare MACE between 2 groups, differences were assessed with the aid of the log-rank test. Cox's proportional hazards regression modeling was used to assess clinical outcomes.
At 12 months after stent implantation, angiography and IVUS follow up were performed in 90.16% patients in AGSI group (55/61), and 94.64% in IGSI group (53/56). In AGSI group, there were 32.73% (18/55) of the patients for whom the stent was extruded into MB while no patient was found in IGSI group (P < .01). In AGSI group, there were 16.36% (9/55) of the patients for whom the stent did not fully cover the stenosis lesion while no patient was found in IGSI group (P < .05). Totally, 49.09% (27/55) of the patients' stents were not positioned exactly. However, the stent was positioned exactly in all patients in IGSI groups. The incidence of MACE was higher in AGSI group than that in IGSI group (18.0% vs 5.4% P < .05). The incidence of target lesion revascularization was higher in AGSI group than that in IGSI group (8.2% vs 0.0% P < .05). Kaplan-Meier survival curves showed that IGSI decreased the risk of 12-mouth MACE ((χ2 = 8.427, Plog-rank = .004). There was a significant correlation between IGSI and MACE events in COX analysis before and after multifactor correction (P < .05).
IVUS guiding leads to shorter stent length, less diameter stenosis, more accurate stent positioning and less MACE and thus optimizes the stent implantation for stenosis proximal to MB.
A total of 117 patients with stenosis proximal to MB were randomly divided into angiography guided stent implantation (AGSI, n = 61) group and IVUS guided stent implantation (IGST n = 56). Major adverse cardiac events (MACE) were followed up to 12 months. Coronary angiography and IVUS were performed at 12 months follow up. Lumen diameter, cross section area and lumen loss was calculated. We constructed Kaplan-Meier curves to compare MACE between 2 groups, differences were assessed with the aid of the log-rank test. Cox's proportional hazards regression modeling was used to assess clinical outcomes.
At 12 months after stent implantation, angiography and IVUS follow up were performed in 90.16% patients in AGSI group (55/61), and 94.64% in IGSI group (53/56). In AGSI group, there were 32.73% (18/55) of the patients for whom the stent was extruded into MB while no patient was found in IGSI group (P < .01). In AGSI group, there were 16.36% (9/55) of the patients for whom the stent did not fully cover the stenosis lesion while no patient was found in IGSI group (P < .05). Totally, 49.09% (27/55) of the patients' stents were not positioned exactly. However, the stent was positioned exactly in all patients in IGSI groups. The incidence of MACE was higher in AGSI group than that in IGSI group (18.0% vs 5.4% P < .05). The incidence of target lesion revascularization was higher in AGSI group than that in IGSI group (8.2% vs 0.0% P < .05). Kaplan-Meier survival curves showed that IGSI decreased the risk of 12-mouth MACE ((χ2 = 8.427, Plog-rank = .004). There was a significant correlation between IGSI and MACE events in COX analysis before and after multifactor correction (P < .05).
IVUS guiding leads to shorter stent length, less diameter stenosis, more accurate stent positioning and less MACE and thus optimizes the stent implantation for stenosis proximal to MB.
Authors
Jia Jia, Jia Jia, Tian Tian, Zhang Zhang, Zhang Zhang, Jia Jia, Zhang Zhang, Xie Xie, Wang Wang, Chen Chen, Li Li
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