Long-Term Outcomes of Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention for Noncomplex Atherosclerotic Lesions

Intravascular ultrasound (IVUS) is a diagnostic modality providing information about lesion characteristics and optimizing results of percutaneous coronary intervention (PCI). The prognostic benefit of routine IVUS use for PCI of noncomplex atherosclerotic lesions is unclear. The purpose of this study was to estimate the long-term outcomes of IVUS-guided versus angiography-guided PCI in patients undergoing revascularization for noncomplex lesions at a single institution. We performed a single-institution, retrospective study of patients who underwent PCI for noncomplex lesions between January 1, 2011 and December 31, 2018. All patients undergoing PCI were enrolled in our institutional PCI registry. Inverse propensity weighting was performed to adjust for unbalanced confounders. The follow-up period was 2 years. The primary outcome was major adverse cardiac events (MACE) defined as a composite of all-cause death, Q-wave myocardial infarction, and target-vessel revascularization (TVR). Secondary endpoints consisted of the individual components of MACE. A total of 1,700 patients were included in this analysis. IVUS-guided PCI was more often utilized in older individuals of White race with a history of chronic lung disease and hypercholesterolemia and upon stable presentations. After adjustment, IVUS-guided PCI was not associated with a statistically significant difference in the primary outcome at 2 years when compared to angiography-guided PCI (9.7% vs 11.5%, p = 0.34). Analysis of the individual components of all-cause death and TVR demonstrated nonsignificant differences between the 2 groups. IVUS-guided PCI was not associated with better 2-year outcomes as compared to an angiography-guided approach for the treatment of noncomplex atherosclerotic lesions. The results should be considered hypothesis generating and larger randomized studies with longer follow-up periods may be needed to further characterize the long-term sequelae of IVUS-guided versus angiography-guided PCI for noncomplex lesions.