Impact of Intravascular Ultrasound and Final Kissing Balloon Dilatation on Long-Term Clinical Outcome in Percutaneous Revascularization with 1-Stent Strategy for Left Main Coronary Artery Stenosis:
Background: It remains uncertain whether intravascular ultrasound (IVUS) use and final kissing balloon (FKB) dilatation would be standard care of percutaneous coronary intervention (PCI) with simple 1-stent technique in unprotected left main coronary artery (LMCA) stenosis. This study sought to investigate impact of IVUS use and FKB dilatation on long-term major adverse cardiac events (MACE) in PCI with simple 1-stent technique for unprotected LMCA stenosis
Methods: Between June 2006 and December 2012, 255 patients underwent PCI with 1 drug-eluting stent for LMCA stenosis were analyzed. Mean follow-up duration was 1,663±946 days. Long-term MACEs were defined as death, non-fatal myocardial infarction (MI), and repeat revascularizations.
Results: During the follow-up, 72 (28.2%) MACEs occurred including 38 (14.9%) deaths, 21 (8.2%) non-fatal MIs, and 13 (5.1%) revascularizations. The IVUS examination and FKB dilatation was done in 158 (62.0%) and 119 (46.7%), respectively. IVUS use (20.3% versus 41.2%; log-rank p<0.001), not FKB dilatation (30.3% versus 26.5%; log-rank p=0.288), significantly reduced MACEs. In multivariate analysis, IVUS use was a negative predictor of MACEs (hazards ratio [HR] 0.52, 95% confidence interval [CI] 0.302 – 0.880; p=0.015), whereas FKB dilatation (HR 1.70, 95% CI 1.01 – 2.85; p=0.045) was a positive predictor of MACEs. In bifurcation LMCA stenosis, IVUS use (18.7% versus 48.0%; log-rank p<0.001) significantly reduced MACEs. In non-bifurcation LMCA stenosis, FKB dilatation showed a trend increased MACEs (log-rank p=0.065). Subgroups analysis showed that there were heterogeneities in the effect of IVUS use and FKB dilatation on the risk for long-term MACEs based on the presence of bifurcation lesions.
Conclusion: IVUS examination is helpful in reducing clinical events in PCI for LMCA bifurcation lesions, whereas unnecessary FKB dilatation after 1-stent technique might be harmful in non-bifurcation LMCA stenosis.