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Clinical outcomes following IVUS-guided stent deployment in a community hospital.

OBJECTIVES
A discrepancy exists in the medical literature as to what effect intravascular ultrasound (IVUS)-guided stent deployment has on target vessel revascularization (TVR) at 6 months. The major endpoints of this study are the need for TVR, defined as clinically driven repeat interventional or surgical therapy of the index vessel at 6 months and major adverse cardiac events.


METHODS
One hundred interventional stent cases (50 IVUS-guided, 50 non-IVUS guided) were randomly selected in a 6-month period (January to June 2001) for review by measurement of minimal luminal diameter (MLD) pre- and post-intervention. Seventy males and 30 females were distributed among the 2 groups. There were a total of 135 lesions (70 IVUS-guided, 65 non-IVUS guided) in the 2 groups. A 6-month follow-up chart review was performed following the initial stenting.


RESULTS
At 6-month follow-up, there were 2 deaths in the IVUS-guided group and 3 deaths in the non-IVUS guided group (p=NS). All deaths were cardiovascular in nature. Post-procedure MLD was 3.58+/-0.08 mm for the IVUS-guided group and 2.88+/-0.09 mm for the non-IVUS guided group [t=5.7 (df, 133); p<0.001]. Ten of 70 IVUS-guided lesions (14.3%) and 3 of 65 non-IVUS guided lesions (4.2%) underwent TVR within the 6-month study period (Chi square=3.62; p=0.057).


CONCLUSION
In this population, IVUS-guided stent deployment does not appear to reduce either the need for TVR or overall cardiovascular mortality at 6 months. The added expense of IVUS does not appear to be warranted.