Intravascular ultrasound (IVUS) guidance for patients undergoing drug-eluting stent (DES) implantation may be associated with lower rates of target vessel failure (TVF) and stent thrombosis vs. angiography guidance, according to three-year follow-up results of the ULTIMATE trial presented Oct. 15 during TCT 2020 and simultaneously published in JACC: Cardiovascular Interventions.

Xiao-Fei Gao, MD, et al., looked at 1,448 all-comers patients at eight Chinese centers undergoing DES who were randomly assigned to IVUS or angiography guidance following coronary angiography.

Results showed that the primary endpoint of risk of TVF at three years occurred in 47 (6.6%) of patients in the IVUS-guided group vs. 76 (10.7%) in the angiography-guided group. The authors explain that this may be “mainly driven by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%, p=0.05).” Further, the safety endpoint of definite / probable stent thrombosis was 0.1% in the IVUS-guided group vs. 1.1% in the angiography-guided group (p=0.02).

“Notably, we found that patients with IVUS-defined optimal PCI had better clinical outcomes than those who underwent non-optimal IVUS,” said Gao et al. Moving forward they add that, “Further studies are warranted to identify the most optimal IVUS-defined criteria and how to achieve these IVUS criteria.”

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: TCT20, Transcatheter Cardiovascular Therapeutics, Percutaneous Coronary Intervention, Drug-Eluting Stents, Angiography

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