Intracoronary Imaging-Guided PSP in DES Implantation

Jun 19, 2020
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Authors:
Park H, Ahn JM, Kang DY, et al.
Citation:
Optimal Stenting Technique for Complex Coronary Lesions: Intracoronary Imaging-Guided Pre-Dilation, Stent Sizing, and Post-Dilation. JACC Cardiovasc Interv 2020;13:1403-1413.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Among patients undergoing DES implantation in complex coronary artery stenosis, imaging-guided pre-dilation, stent sizing, and post-dilation (iPSP) was associated with a lower risk of cardiac events at 3 years.
  • The clinical benefit of iPSP may be attributed to effective post-dilation, with the larger final balloon size guided by intracoronary imaging.
  • Given the limitations of the current observational study, these findings need to be confirmed in randomized controlled trials to confirm the effects of iPSP prior to widespread clinical application.

Study Questions:

What are the 3-year outcomes of intracoronary imaging-guided pre-dilation, stent sizing, and post-dilation (iPSP) for patients with complex coronary artery lesions?

Methods:

The investigators evaluated 9,525 patients who underwent percutaneous coronary intervention for left main, bifurcation, long or diffuse (>30 mm), or angiographically severely calcified lesions from the IRIS-DES (Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents) registry. The primary outcome was a composite of cardiac death, target vessel myocardial infarction (MI), and target vessel revascularization (TVR). The authors used multiple Cox proportional hazards regression model with prespecified adjusting factors, propensity score matching, and weighted Cox proportional hazards regression models with the inverse probability of treatment weighting to adjust for confounding factors.

Results:

At the index procedure, intravascular ultrasound assessment PSP was performed in 8,522 (89.5%), 5,141 (54.0%), and 5,531 (58.1%) patients, respectively; overall, 3,374 (35.4%) patients underwent stent implantation using all three parts of the iPSP strategy and were defined as the iPSP group. At 3 years, the adjusted rate of the primary outcome was significantly lower in the iPSP group (5.6% vs. 7.9%; adjusted hazard ratio, 0.71; 95% confidence interval, 0.63-0.81; p < 0.001).

Conclusions:

The authors concluded that among patients undergoing DES implantation in complex coronary artery stenosis, iPSP was associated with a lower risk of cardiac events at 3 years.

Perspective:

This registry study reports that the so-called iPSP strategy was significantly associated with a lower risk of cardiac death, target vessel MI, or TVR at 3 years in patients with complex coronary artery disease. The clinical benefit of iPSP may be attributed to effective post-dilation, with the larger final balloon size guided by intracoronary imaging. These data suggest that physicians recognize the value of iPSP strategy and consider it for the treatment of complex coronary artery stenosis in appropriate patients. Given the limitations of the current observational study, these findings need to be confirmed in randomized controlled trials to confirm the effects of iPSP prior to widespread clinical application.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound

Keywords: Coronary Artery Disease, Coronary Stenosis, Death, Sudden, Cardiac, Diagnostic Imaging, Dilatation, Drug-Eluting Stents, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Secondary Prevention, Ultrasonography, Interventional


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