[TCT2007]IVUS Guidance Needed for DES Left Main Procedures

In-hospital outcomes similar among left main patients treated with DES and bare-metal stents.

Recent registry results shed light on the role IVUS can play in DES intervention in left main coronary disease, and a further meta-analysis of comparative trials explores how treatment choices can affect mortality.

IVUS guidance during DES treatment was associated with a significant reduction in mortality (HR = 0.429; 95% CI, 0.211-0.872) in the MAIN-COMPARE registry, according to Seung-Jung Park, MD, professor of medicine at the University of Ulsan College of Medicine in Seoul, Korea.

Three-year survival among patients receiving IVUS-guided therapy was significantly higher compared with patients treated without IVUS guidance (Figure 1).

The registry compared CABG to stenting with either bare-metal stents or DES, depending on the year of enrollment.

There was no difference in all-cause mortality between bare-metal stents, DES, or CABG.

Stent thrombosis, by any of the definitions endorsed by the Academic Research Consortium, occurred in 0.9% (5 of 570 patients). Three cases occurred with bare-metal stents and two occurred with DES (Figure 2).

Stent thrombosis-free survival at 3 years was 99.4% among patients treat¬ed with DES and 98.8% among pa¬tients treated with bare-metal stents.

The MAIN-COMPARE registry began in January 2000 and enrolled 775 patients with left main CAD who had been treated with bare-metal stents (n = 336) or CABG (n = 439). In phase II, which began in March 2003, treatment strategies shifted from bare-metal stents to DES; 805 patients were treated with DES and 731 patients were treated with CABG.

Further meta-analysis

Park presented a meta-analysis of 3,976 patients to determine overall safety and efficacy associated with left main intervention.

Bare-metal stents and DES were associated with a significant reduction in TVR at 3 years compared with CABG.
DES implantation alone also was associated with a significant reduction in TVR compared with CABG.

Treatment with DES was associated with a 57% reduction in adjust¬ed mortality (P = .027) primarily driven by a 71% reduction in deaths from cardiovascular causes.

The adjusted mortality rate was similar between DES and bare-metal stents.

A EuroSCORE of at least 6 was an independent predictor of mortality (HR = 3.494; 95% CI, 1.489-8.197) among patients treated with bare-metal stents.

Among patients treated with DES, previous CHF (HR = 2.658; 95% CI, 1.032-6.847), chronic renal failure (HR = 4.865; 95% CI, 2.102-11.257), COPD (HR = 2.927; 95% CI, 1.004-8.534) and a EuroSCORE of at least 6 (HR = 3.243; 95% CI, 1.482-7.094) were all independent predictors of mortality.