Long-term outcomes of intravascular ultrasound-guided drug-eluting stents implantation in patients with acute coronary syndrome: ULTIMATE ACS subgroup
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目的 评估血管内超声（IVUS）指导药物洗脱支架（DES）置入对急性冠脉综合征（ACS）患者长期临床结局的影响。 方法 研究对象来源于ULTIMATE研究，该研究是一项前瞻性、多中心、随机对照研究，于2014年8月—2017年5月在国内8家医院入选1 448例置入DES的冠心病患者。本研究为ULTIMATE研究的亚组分析，将冠心病患者分为ACS组和非ACS组，2组患者均在IVUS或冠状动脉造影指导下置入DES。主要终点是术后3年靶血管失败（TVF）率，包含心原性死亡、靶血管心肌梗死和临床驱动的靶血管血运重建。 结果 1 448例冠心病患者中，ACS组1 136例（78.5%），1 423例（98.3%）患者完成术后3年随访。ACS组患者术后3年的TVF发生率为9.6%（109/1 136），高于非ACS组的4.5%（14/312），log-rank P=0.005。ACS组中IVUS指导下置入DES者的TVF发生率低于冠状动脉造影指导下置入DES架者［7.6%（43/569）比11.6%（66/567），log-rank P=0.019］。ACS组中IVUS指导下DES置入达标组患者术后3年的TVF发生率为5.4%（16/296），低于IVUS未达标组的9.9%（27/273），log-rank P=0.041。 结论 ACS患者置入DES后3年的TVF事件率高于无ACS患者；相比于冠状动脉造影，IVUS指导DES置入可以降低ACS患者术后3年的TVF事件，尤其是IVUS指导下DES置入达标的患者获益更明显。 Objective To explore the long-term effects of intravascular ultrasound (IVUS) guidance on patients with acute coronary syndrome (ACS) undergoing drug-eluting stents (DES) implantation. Methods Data used in this study derived from ULTIMATE trial, which was a prospective, multicenter, randomized study. A total of 1 448 all-comer patients were enrolled between 2014 August and 2017 May. Primary endpoint of this study was target vessel failure (TVF) at 3 years, including cardiac death, target-vessel-related myocardial infarction, and clinically-driven target vessel revascularization. Results ACS was present in 1 136 (78.5%) patients, and 3-year clinical follow-up was available in 1 423 patients (98.3%). TVF in the ACS group was 9.6% (109/1 136), which was significantly higher than 4.5% (14/312) in the non-ACS group (log-rank P=0.005). There were 109 TVFs in the ACS patients, with 7.6% (43/569) TVFs in the IVUS group and 11.6% (66/567) TVFs in the angiography group (log-rank P=0.019). Moreover, patients with optimal IVUS guidance were associated with a lower risk of 3-year TVF compared to those with suboptimal IVUS results (5.4% (16/296) vs. 9.9% (27/273),log-rank P=0.041). Conclusions This ULTIMATE-ACS subgroup analysis showed that ACS patients undergoing DES implantation were associated with a higher risk of 3-year TVF. More importantly, the risk of TVF could be significantly decreased through IVUS guidance in patients with ACS, especially in those who had an IVUS-defined optimal procedure.
Objective To explore the long-term effects of intravascular ultrasound (IVUS) guidance on patients with acute coronary syndrome (ACS) undergoing drug-eluting stents (DES) implantation. Methods Data used in this study derived from ULTIMATE trial, which was a prospective, multicenter, randomized study. A total of 1 448 all-comer patients were enrolled between 2014 August and 2017 May. Primary endpoint of this study was target vessel failure (TVF) at 3 years, including cardiac death, target-vessel-related myocardial infarction, and clinically-driven target vessel revascularization. Results ACS was present in 1 136 (78.5%) patients, and 3-year clinical follow-up was available in 1 423 patients (98.3%). TVF in the ACS group was 9.6% (109/1 136), which was significantly higher than 4.5% (14/312) in the non-ACS group (log-rank P=0.005). There were 109 TVFs in the ACS patients, with 7.6% (43/569) TVFs in the IVUS group and 11.6% (66/567) TVFs in the angiography group (log-rank P=0.019). Moreover, patients with optimal IVUS guidance were associated with a lower risk of 3-year TVF compared to those with suboptimal IVUS results (5.4% (16/296) vs. 9.9% (27/273),log-rank P=0.041). Conclusions This ULTIMATE-ACS subgroup analysis showed that ACS patients undergoing DES implantation were associated with a higher risk of 3-year TVF. More importantly, the risk of TVF could be significantly decreased through IVUS guidance in patients with ACS, especially in those who had an IVUS-defined optimal procedure.
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