Skip to main content
SpringerLink
Log in

Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era.

Methods

A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)].

Results

A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05).

Conclusions

Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS, COURAGE trial research group (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516

    Article  PubMed  CAS  Google Scholar 

  2. Al Suwaidi J, Yeh W, Cohen HA, Detre KM, Williams DO, Holmes DR Jr (2001) Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry). Am J Cardiol 87:1139–1144

    Article  PubMed  CAS  Google Scholar 

  3. Hoffmann R, Klinker H, Adamu U, Kelm M, Blindt R (2009) The risk of definitive stent thrombosis is increased after “off-label” stent implantation irrespective of drug-eluting stent or bare-metal stent use. Clin Res Cardiol 98:549–554

    Article  PubMed  CAS  Google Scholar 

  4. Capodanno D, Capranzano P, Bucalo R, Sanfilippo A, Ruperto C, Caggegi A, Ussia G, Galassi AR, Tamburino C (2009) A novel approach to define risk of stent thrombosis after percutaneous coronary intervention with drug-eluting stents: the DERIVATION score. Clin Res Cardiol 98:240–248

    Article  PubMed  CAS  Google Scholar 

  5. Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schömig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabaté M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, Petronio AS, Nordmann AJ, Diem P, Meier B, Zwahlen M, Reichenbach S, Trelle S, Windecker S, Jüni P (2007) Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 370:937–948

    Article  PubMed  CAS  Google Scholar 

  6. Colombo F, Biondi-Zoccai G, Infantino V, Omedé P, Moretti C, Sciuto F, Siliquini R, Chiadò S, Trevi GP, Sheiban I (2009) A long-term comparison of drug-eluting versus bare metal stents for the percutaneous treatment of coronary bifurcation lesions. Acta Cardiol 64:583–588

    Article  PubMed  Google Scholar 

  7. Qasim A, Cosgrave J, Latib A, Colombo A (2007) Long-term follow-up of drug-eluting stents when inserted for on- and off-label indications. Am J Cardiol 100:1619–1624

    Article  PubMed  CAS  Google Scholar 

  8. Garrone P, Biondi-Zoccai G, Salvetti I, Sina N, Sheiban I, Stella PR, Agostoni P (2009) Quantitative coronary angiography in the current era: principles and applications. J Interv Cardiol 22:527–536

    Article  PubMed  Google Scholar 

  9. Biondi-Zoccai GG, Giraudi E, Moretti C, Sciuto F, Omedè P, Sillano D, Garrone P, Trevi GP, Sheiban I (2010) Impact of routine angiographic follow-up after percutaneous coronary drug-eluting stenting for unprotected left main disease: the Turin Registry. Clin Res Cardiol 99:235–242

    Article  PubMed  Google Scholar 

  10. Mudra H, di Mario C, de Jaegere P, Figulla HR, Macaya C, Zahn R, Wennerblom B, Rutsch W, Voudris V, Regar E, Henneke KH, Schächinger V, Zeiher A, OPTICUS (OPTimization with ICUS to reduce stent restenosis) study investigators (2001) Randomized comparison of coronary stent implantation under ultrasound or angiographic guidance to reduce stent restenosis (OPTICUS Study). Circulation 104:1343–1349

    Article  PubMed  CAS  Google Scholar 

  11. Casella G, Klauss V, Ottani F, Siebert U, Sangiorgio P, Bracchetti D (2003) Impact of intravascular ultrasound-guided stenting on long-term clinical outcome: a meta-analysis of available studies comparing intravascular ultrasound-guided and angiographically guided stenting. Catheter Cardiovasc Interv 59:314–321

    Article  PubMed  Google Scholar 

  12. Russo RJ, Silva PD, Teirstein PS, Attubato MJ, Davidson CJ, DeFranco AC, Fitzgerald PJ, Goldberg SL, Hermiller JB, Leon MB, Ling FS, Lucisano JE, Schatz RA, Wong SC, Weissman NJ, Zientek DM (2009) AVID Investigators. A randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID Trial). Circ Cardiovasc Interv 2:113–123

    Article  PubMed  Google Scholar 

  13. Roy P, Steinberg DH, Sushinsky SJ, Okabe T, Pinto Slottow TL, Kaneshige K, Xue Z, Satler LF, Kent KM, Suddath WO, Pichard AD, Weissman NJ, Lindsay J, Waksman R (2008) The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J 29:1851–1857

    Article  PubMed  CAS  Google Scholar 

  14. Costantini CO, Tarbine SG, Santos MF, Bubna M, Medeiros MA, Barbosa M, Duarte E, Denk MA, Sipraki R, Costantini CR (2008) Impact of intravascular ultrasound to guide drug eluting stent implantation decreasing long term clinical events. Am J Cardiol 102:161i

    Google Scholar 

  15. Agostoni P, Valgimigli M, Van Mieghem CAG, Rodriguez-Granillo GA, Aoki J, Ong ATL, Tsuchida K, McFadden EP, Ligthart JM, Smits PC, de Jaegere P, Sianos G, Van der Giessen WJ, De Feyter P, Serruys PW (2005) Comparison of early outcome of percutaneous coronary intervention for unprotected left main coronary artery disease in the drug-eluting stent era with versus without intravascular ultrasonic guidance. Am J Cardiol 95:644–647

    Article  PubMed  Google Scholar 

  16. Park SJ, Kim YH, Park DW, Lee SW, Kim WJ, Suh J, Yun SC, Lee CW, Hong MK, Lee JH, Park SW, MAIN-COMPARE investigators (2009) Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv 2:167–177

    Article  PubMed  Google Scholar 

  17. Kim SH, Kim YH, Kang SJ, Park DW, Lee SW, Lee CW, Hong MK, Cheong SS, Kim JJ, Park SW, Park SJ (2010) Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions. Am J Cardiol 106:612–618

    Article  PubMed  Google Scholar 

  18. Romagnoli E, De Servi S, Tamburino C, Colombo A, Burzotta F, Presbitero P, Bolognese L, Paloscia L, Rubino P, Sardella G, Briguori C, Ettori F, Franco G, Di Girolamo D, Sheiban I, Piatti L, Greco C, Petronio S, Loi B, Lioy E, Benassi A, Patti A, Gaspardone A, Capodanno D, Biondi-Zoccai GG, Sangiorgi G, I-BIGIS study group (2010) Real-world outcome of coronary bifurcation lesions in the drug-eluting stent era: results from the 4,314-patient Italian Society of Invasive Cardiology (SICI-GISE) Italian Multicenter Registry on Bifurcations (I-BIGIS). Am Heart J 160:535–542.e1

    Article  PubMed  Google Scholar 

  19. Biondi-Zoccai G, Romagnoli E, Agostoni P, Capodanno D, Castagno D, D’ascenzo F, Sangiorgi G, Modena MG (2011) Are propensity scores really superior to standard multivariable analysis? Contemp Clin Trials. doi:10.1016/j.cct.2011.05.006

  20. Albiero R, Rau T, Schlüter M, Di Mario C, Reimers B, Mathey DG, Tobis JM, Schofer J, Colombo A (1997) Comparison of immediate and intermediate-term results of intravascular ultrasound versus angiography-guided Palmaz-Schatz stent implantation in matched lesions. Circulation 96:2997–3005

    PubMed  CAS  Google Scholar 

  21. Jakabcin J, Spacek R, Bystron M, Kvasnák M, Jager J, Veselka J, Kala P, Cervinka P (2010) Long-term health outcome and mortality evaluation after invasive coronary treatment using drug eluting stents with or without the IVUS guidance. Randomized control trial. HOME DES IVUS. Catheter Cardiovasc Interv 75:578–583

    PubMed  Google Scholar 

  22. Biondi-Zoccai GG, Chieffo A, Agostoni P, Colombo A (2005) Applying intravascular ultrasound to optimize the placement of coronary drug-eluting stents. Minerva Cardioangiol 53:165–176

    PubMed  CAS  Google Scholar 

  23. Kim WH, Lee BK, Lee S, Shim JM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK (2010) Serial changes of minimal stent malapposition not detected by intravascular ultrasound: follow-up optical coherence tomography study. Clin Res Cardiol 99:639–644

    Article  PubMed  Google Scholar 

  24. Biondi-Zoccai G, Sheiban I, Moretti C, Palmerini T, Marzocchi A, Capodanno D, Tamburino C, Margheri M, Vecchi G, Sangiorgi G, Santarelli A, Bartorelli AL, Briguori C, Vignali L, Pede F, Ramondo A, Medda M, de Carlo M, Falsini G, Benassi A, Palmieri C, Filippone V, Sangiorgi D, Barlocco F, de Servi S (2011) Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: insights from a multicenter registry of 975 patients. Clin Res Cardiol 100:403–411

    Article  PubMed  Google Scholar 

  25. Zahn R, Hamm CW, Zeymer U, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Nienaber CA, Pfannebecker T, Senges J (2010) Coronary stenting with the sirolimus-eluting stent in patients with restenosis after intracoronary brachytherapy: results from the prospective multicentre German Cypher Stent Registry. Clin Res Cardiol 99:99–106

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Dr. Biondi-Zoccai has lectured for Boston Scientific and Volcano.

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy

    Giuseppe Biondi-Zoccai

  2. Division of Cardiology, University of Turin, Turin, Italy

    Imad Sheiban

  3. Division of Cardiology, Policlinico Casilino, Rome, Italy

    Enrico Romagnoli

  4. Interventional Cardiology, San Raffaele Institute, and EMO-GVM Centro Cuore Columbus, Milan, Italy

    Antonio Colombo

  5. Dipartimento Cardiovascolare, Ospedale di Legnano, Milan, Italy

    Stefano De Servi

  6. Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy

    Corrado Tamburino & Davide Capodanno

  7. Institute of Cardiology, Catholic University, Rome, Italy

    Francesco Burzotta

  8. Division of Cardiology, Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Patrizia Presbitero

  9. Cardiovascular Department, San Donato Hospital, Arezzo, Italy

    Leonardo Bolognese

  10. Interventional Cardiology, Santo Spirito Hospital, Pescara, Italy

    Leonardo Paloscia

  11. Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy

    Paolo Rubino

  12. Cardiovascular Sciences, Policlinico Umberto I, Rome, Italy

    Gennaro Sardella

  13. Division of Cardiology, Clinica Mediterranea, Naples, Italy

    Carlo Briguori

  14. Interventional Cardiology, Spedali Civili, Brescia, Italy

    Luigi Niccoli

  15. Interventional Cardiology, Mater Salutis Hospital, Legnago, Italy

    Gianfranco Franco

  16. Interventional Cardiology, San Sebastiano Hospital, Caserta, Italy

    Domenico Di Girolamo

  17. Interventional Cardiology, Manzoni Hospital, Lecco, Italy

    Luigi Piatti

  18. Second Division of Cardiology, Department of Heart and Great Vessels ‘Attilio Reale’, University of Rome, Rome, Italy

    Cesare Greco

  19. Division of Cardiology, University of Tor Vergata, Rome, Italy

    Giuseppe Sangiorgi

Authors
  1. Giuseppe Biondi-Zoccai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Imad Sheiban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enrico Romagnoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano De Servi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Corrado Tamburino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Burzotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Patrizia Presbitero
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leonardo Bolognese
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Leonardo Paloscia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paolo Rubino
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gennaro Sardella
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Carlo Briguori
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Luigi Niccoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Gianfranco Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Domenico Di Girolamo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Luigi Piatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Cesare Greco
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Davide Capodanno
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Giuseppe Sangiorgi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Biondi-Zoccai.

Additional information

For the Italian Multicenter Registry on Bifurcation Study (I-BIGIS) Group.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Biondi-Zoccai, G., Sheiban, I., Romagnoli, E. et al. Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry. Clin Res Cardiol 100, 1021–1028 (2011). https://doi.org/10.1007/s00392-011-0336-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-011-0336-x

Keywords

Search

Navigation