The use of intravascular ultrasound (IVUS) was associated with improved clinical outcomes when used during drug-eluting stent (DES) implantation in all-comers patients, new study results suggest.
Researchers for the ULTIMATE study, presenting at TCT 2018 in San Diego, enrolled a total of 1,448 all-comer patients undergoing DES implantation and randomly assigned them (1:1) to either IVUS guidance or guidance (n=724) by angiography (n=724). The primary endpoint was target vessel failure at 1 year (cardiac death, target vessel myocardial infarction), and clinical driven target vessel revascularization.
According to the study results, primary and secondary endpoints were comparable between study groups at 30 days. At 1 year post-PCI, 21 target vessel failures had occurred in the IVUS group compared to 39 in the angiography group (HR=0.530; 95% CI, 0.312 to 0.901; P=0.019). In the IVUS cohort, target vessel failure occurred in 1.6% of patients compared to 4.4% in patients failing all optimal criteria (HR=0.349; 95% CI, 0.135 to 0.898; P=0.029). The results of a patient-level analysis did not indicate a significant reduction in clinically driven target lesion revascularization or definite stent thrombosis.
“The study demonstrated that IVUS-guided stent implantation significantly improved clinical outcomes in all-comers, particularly for patients who had an IVUS-defined optimal procedure, compared to angiography guidance,” Junjie Zhang, MD, Vice Director of the Cardiovascular Department at Nanjing First Hospital in Nanjing Medical University in Nanjing, China, said in a press release. “While previous studies and this trial have demonstrated the overall favorable effect of IVUS guidance for patients with particular lesion subsets, this study further reports that achievement of IVUS-defined optimal PCI improves clinical outcomes for all-comers.”