NEW YORK (Reuters Health) – Intravascular ultrasound guidance (IVUS) in patients treated with drug-eluting stent for bifurcation lesions, may improve long-term clinical outcomes, Korean researchers report in the January issue of the American Heart Journal.

Dr. Myeong-Ki Hong of Yonsei University College of Medicine, Seoul and colleagues note that treatment of coronary bifurcation lesions is still an unresolved issue because of a lower procedural success and unfavorable clinical outcomes compared to that of nonbifurcation lesions.

To investigate whether IVUS might improve outcome, the team examined registry data on 487 patients with IVUS guidance and 487 patients with angiographic guidance who underwent drug-eluting stent implantation.

Success, overall, was similar for both main vessel and side branch procedures. As to complications, periprocedural elevation of cardiac enzymes was more frequent in the angiography guidance group. Also, there were 2 cases of subacute stent thrombosis in the angiography group. There were none in the IVUS group.

After a mean follow-up of almost 2 years, the incidence of death or myocardial infarction (MI) was significantly less in the IVUS group than in angiography patients (3.8% versus 7.8%).

Nevertheless, target lesion revascularization (TLR) did not differ significantly (7.4% versus 6.7%). This was also true of major adverse cardiac events including death, MI or TLR (10.9% versus 12.1%). There were similar findings for other outcome measures.

Previous studies using bare metal stents, say the investigators, showed that IVUS guidance during PCI reduced the rate of in-stent restenosis and the incidence of reintervention.

They add that the current study had several limitations, but it appears that the approach might improve long-term outcomes. However, the researchers conclude that the findings should be validated in randomized clinical trials with long-term clinical follow-up and a larger population.

Am Heart J 2011;161:180-187.