Background:Intravascular ultrasound (IVUS) has several benefits during percutaneous coronary interventions (PCIs), including more accurate vessel sizing, improved stent expansion, and better strut apposition. Prior clinical trials have demonstrated a reduction in cardiac events when IVUS is used. However, there is limited information about the utilization of IVUS and the outcomes of IVUS-guided versus angiography-guided PCI in patients with complex lesions in a contemporary population-based setting.Methods:New York’s PCI registry was used to identify 44 305 patients with complex lesions (lesions that complicate stenting or that require multiple stents) undergoing PCI with and without IVUS guidance and discharged between December 1, 2013 and November 30, 2018. Trends and inter-hospital variation in IVUS use were examined. Risk-adjusted mortality and target vessel revascularization were compared.Results:A total of 6174 (13.9%) PCI patients underwent IVUS-guided PCI. The median follow-up period was 2.5 years. The percent of patients with complex lesions who underwent IVUS-guided PCI rose from 13.4% in 2014 to 16.5% in 2018 (P<0.0001 for trend), with the main increases occurring in the last 2 years of the period. Only 31 of 66 hospitals in the study used IVUS for >5% of their study patients. IVUS-guided PCI patients experienced significantly lower mortality (adjusted hazard ratio=0.89 [0.79–0.98] after adjustment using a Cox proportional hazards model, and HR=0.88 [0.78–0.99] for propensity-matched patients). We also found that IVUS-guided PCI patients had a lower rate of target vessel revascularization (adjusted hazard ratio=0.88 [0.80–0.97]) after adjusting using Cox proportional hazards with competing risk of mortality and after propensity matching (0.88 [0.79–0.99]).Conclusions:Utilization of IVUS for complex lesions has increased but contemporary rates remain low, and there are large inter-hospital variations. The use of IVUS for complex lesions was associated with lower risk of medium-term mortality and target vessel revascularization.

中文翻译：

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复杂病变患者的经皮冠状动脉介入治疗（加和不加血管内超声）：利用率、死亡率和靶血管血运重建

背景：血管内超声 (IVUS) 在经皮冠状动脉介入治疗 (PCI) 中具有多项优势，包括更准确的血管尺寸、改善的支架扩张和更好的支架贴合。先前的临床试验表明，使用 IVUS 可减少心脏事件。然而，在当代以人群为基础的情况下，关于 IVUS 的利用以及 IVUS 引导与血管造影引导的 PCI 在复杂病变患者中的结果的信息有限。方法：纽约的 PCI 登记用于识别 44 305 名患有复杂病变的患者。在 2013 年 12 月 1 日至 2018 年 11 月 30 日期间，在有和没有 IVUS 指导的情况下接受 PCI 并出院的复杂病变（使支架置入复杂或需要多个支架的病变）。检查了 IVUS 使用的趋势和医院间差异。比较风险调整死亡率和靶血管血运重建。结果：共有 6174 名 (13.9%) PCI 患者接受了 IVUS 引导的 PCI。中位随访时间为 2.5 年。接受 IVUS 引导 PCI 的复杂病变患者比例从 2014 年的 13.4% 上升到 2018 年的 16.5%（磷<0.0001（趋势），主要增长发生在该时期的最后 2 年。研究中的 66 家医院中只有 31 家对 >5% 的研究患者使用了 IVUS。IVUS 引导的 PCI 患者死亡率显着降低（使用 Cox 比例风险模型调整后的调整风险比 = 0.89 [0.79-0.98]，倾向匹配患者的 HR = 0.88 [0.78-0.99]）。我们还发现，在使用具有竞争死亡风险的 Cox 比例风险和倾向匹配 (0.88 [0.79-0.99] ]). 结论：IVUS 对复杂病变的利用有所增加，但目前的比率仍然很低，并且存在较大的医院间差异。