Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound

Amgad Mentias; Mary Vaughan Sarrazin; Marwan Saad; Sidakpal Panaich; Samir Kapadia; Phillip A. Horwitz; Saket Girotra

doi:10.1016/j.jcin.2020.04.052

Back

Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound

Journal article

Open access

Peer reviewed

Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound

Amgad Mentias, Mary Vaughan Sarrazin, Marwan Saad, Sidakpal Panaich, Samir Kapadia, Phillip A. Horwitz and Saket Girotra

JACC. Cardiovascular interventions, Vol.13(16), pp.1880-1890

08/24/2020

DOI: 10.1016/j.jcin.2020.04.052

PMCID: PMC7444477

PMID: 32819477

Files and links (1)

url

https://doi.org/10.1016/j.jcin.2020.04.052View

Published (Version of record) Open Access

Abstract

This study sought to explore if intravascular ultrasound (IVUS) use in real-world patients is associated with improved long-term outcomes of percutaneous coronary intervention (PCI). The benefit of IVUS use with PCI in real world is uncertain. We identified Medicare patients who underwent PCI from 2009 to 2017 and evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. We used propensity score matching and inverse probability weighting to adjust for baseline characteristics. To account for hospital effects, patients undergoing IVUS-guided PCI were matched to non-IVUS patients in the same hospital and year. Sensitivity analyses comparing outcomes with and without IVUS in stable coronary artery disease and acute coronary syndrome, PCI with bare-metal stents and drug-eluting stents, complex and noncomplex PCI, and facilities with 1% to 5%, 5% to 10%, and >10% IVUS use were performed. Overall, IVUS was used in 5.6% of all PCI patients (105,787 out of 1,877,177 patients). Patients with IVUS-guided PCI had a higher prevalence of most comorbidities. In the propensity matched analysis, IVUS-guided PCI was associated with lower 1-year mortality (11.5% vs. 12.3%), MI (4.9% vs. 5.2%), and repeat revascularization (6.1% vs. 6.7%) (p < 0.001 for all). In inverse probability weighting analysis with a median follow-up of 3.7 years (interquartile range: 1.7 to 6.4 years), IVUS-guided PCI was associated with a lower risk of mortality (adjusted hazard ratio [aHR]: 0.903; 95% confidence interval [CI]: 0.885 to 0.922), MI (aHR: 0.899; 95% CI: 0.893 to 0.904), and repeat revascularization (aHR: 0.893; 95% CI: 0.887 to 0.898) (p < 0.001 for all). These findings were consistent in all subgroups in sensitivity analyses. In this contemporary U.S. Medicare cohort, the use of IVUS guidance in PCI remains low. Use of IVUS is associated with lower long-term mortality, MI, and repeat revascularization. [Display omitted] [Display omitted]

intravascular ultrasound

mortality

myocardial infarction

percutaneous coronary intervention

Details

Title: Subtitle: Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound
Creators: Amgad Mentias - University of Iowa
Mary Vaughan Sarrazin - Iowa City VA Medical Center
Marwan Saad - Brown University
Sidakpal Panaich - University of Iowa
Samir Kapadia - Cleveland Clinic
Phillip A. Horwitz - University of Iowa
Saket Girotra - University of Iowa
Resource Type: Journal article
Publication Details: JACC. Cardiovascular interventions, Vol.13(16), pp.1880-1890
DOI: 10.1016/j.jcin.2020.04.052
PMID: 32819477
PMCID: PMC7444477
NLM abbreviation: JACC Cardiovasc Interv
ISSN: 1936-8798
eISSN: 1876-7605
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000002, name: National Institutes of Health
Language: English
Date published: 08/24/2020
Academic Unit: Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
Record Identifier: 9984359775002771

Metrics

17 Record Views

86 Times Cited - Web of Science