Zhang J, et al. Late-breaking clinical science session II: Complex PCI strategies. Presented at: TCT Connect; Oct. 14-18, 2020 (virtual meeting).
ULTIMATE: IVUS-guided PCI superior to angiography guidance at 3 years
In patients undergoing PCI with a drug-eluting stent, those whose procedures were guided by IVUS had less target vessel failure at 3 years than those whose procedures were guided by angiography, new data from the ULTIMATE trial showed.
As Healio previously reported, in the all-comers trial of 1,448 patients, IVUS-guided PCI was associated with lower TVF rates compared with angiography-guided PCI at 1 year. Jun-Jie Zhang, MD, PhD, associate professor, director of the cardiac catheter laboratory and vice director of cardiovascular development at Nanjing First Hospital, Nanjing Medical University, China, presented the 3-year results, which were simultaneously published in JACC: Cardiovascular Interventions, at the virtual TCT Connect.
At 3 years, among the 1,423 patients for whom data were available, TVF, defined as cardiac death, target vessel MI and clinically driven target vessel revascularization, occurred in 6.6% of the IVUS group compared with 10.7% of the angiography group (HR = 0.6; 95% CI, 0.42-0.87), Zhang said during a presentation.
In the IVUS group, patients were stratified by whether they were able to receive optimal PCI, defined as minimal lumen cross-sectional area greater than 5 mm2 in the stented segment or 90% of the distal reference lumen cross-sectional area, plaque burden less than 50% at the 5 mm proximal or distal to the stent edge and no edge dissection involving media with length greater than 3 mm.
Those with optimal PCI had a 3-year TVF rate of 4.2% compared with 9.2% for those with suboptimal PCI (HR = 0.44; 95% CI, 0.24-0.81), “which means we should not only insert an IVUS catheter into the vessel, but we should also follow the IVUS assessment and results to further optimize the stent result,” Zhang said during the presentation.
The results did not vary according to any prespecified subgroups, he said.
The mean age of patients was 66 years and 74% were men.
“IVUS guidance was associated with lower risk of 3-year TVF, particularly for patients with IVUS-defined optimal procedures compared with angiographic guidance in all comers undergoing second-generation DES implantation,” Zhang said.