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Perspective from Jay Giri, MD, MPH, FAHA
October 25, 2019
2 min read
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IVUS-XPL: In long lesions, IVUS-guided PCI retains superior outcomes at 5 years

Perspective from Jay Giri, MD, MPH, FAHA
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Myeong-Ki Hong

SAN FRANCISCO — Among patients who underwent PCI for long lesions, IVUS-based guidance was associated with better outcomes than angiography-based guidance at 5 years, according to new data from the IVUS-XPL trial presented at TCT 2019.

As Healio previously reported, at 1 year, among patients who had PCI with an everolimus-eluting stent (Xience Prime, Abbott Vascular), those who had IVUS guidance had reduced risk for MACE (HR = 0.48; 95% CI, 0.28-0.83).

In the 5-year results, presented here by Myeong-Ki Hong, MD, PhD, professor of medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine in Seoul, South Korea, and published in JACC: Cardiovascular Interventions, MACE remained lower in the IVUS group compared with the angiography group (5.6% vs. 10.7%; HR = 0.5; 95% CI, 0.34-0.75). MACE was defined as cardiac death, target lesion-related MI or ischemia-driven target lesion revascularization.

As with the 1-year results, the 5-year results were mainly driven by differences in ischemia-driven TLR (4.8% vs. 8.4%; HR = 0.54; 95% CI, 0.33-0.89), Hong said during a presentation.

When the researchers performed a landmark analysis, they determined that between 1 year and 5 years, the rates of MACE were 2.8% in the IVUS group and 5.2% in the angiography group (HR = 0.53; 95% CI, 0.29-0.95).

Other 5-year analyses showed the treatment effect was similar across all subgroups.

“Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years postimplantation, even in the current DES implantation era,” Hong said during the presentation.

The cohort included 1,400 patients (mean age, 64 years; 69% men; minimum estimated stent length, 28 mm), of whom 589 from the IVUS group and 594 from the angiography group completed 5-year follow-up. – by Erik Swain

References:

Hong M-K, et al. Late-Breaking Science 4. Presented at: TCT Scientific Symposium; Sept. 25-29, 2019; San Francisco.

Hong S-J, et al. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.09.033.

Disclosures: Hong reports no relevant financial disclosures. Another author reports he consults for Boston Scientific, Philips/Volcano and Terumo.