Intravascular ultrasound Guidance in Complex PCI Shows Long-term Benefits in Reducing Cardiac Events: JACC

The benefit of IVUS added over angiography was more prominent when operators had an experience of fewer than five years. The findings were published in the journal JACC: Cardiovascular Interventions in its July 24, 2023 issue.

According to the authors, experienced operators used IVUS more frequently compared with less-experienced operators. Second, patients treated by less-experienced operators demonstrated a comparable long-term risk of target-vessel MI or cardiac death to those treated by experienced operators when IVUS was used during complex PCI.

Consistent clinical data support the use of intravascular ultrasound during complex PCI (percutaneous coronary intervention), but there is a lack of long-term follow-up outcomes on differential effects of IVUS per operator experience. Ki Hong Choi, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, and colleagues aimed to evaluate the impact of operator experience on long-term clinical outcomes, lesion complexity, and the interactions of IVUS guidance in patients undergoing complex PCI.

For this purpose, the researchers recruited 6,005 patients who underwent PCI with drug-eluting stents (DES) for complex lesions from the institutional registry of Samsung Medical Center. The study's participants were stratified by IVUS use and operator experience (less experienced operator [lifetime independent experience with PCI ≤5 years] versus experienced operator).

The primary endpoint of the study was determined as a composite of cardiac death or target vessel MI up to 10 years.

The authors reported the following findings:

• Compared with less experienced operators, experienced operators used IVUS more frequently (29.6% versus 24.8%) and achieved a lower risk of cardiac death or TVMI (experienced vs less experienced, adjusted HR: 0.779).
• IVUS use was associated with a significantly lower risk of cardiac death or TVMI than angiography alone for less experienced operators (23.5% vs 11.4%; adjusted HR: 0.477) as well as experienced operators (18.0% vs 13.5%; adjusted HR: 0.747).
• There were significant interactions for the risk of cardiac death or TVMI between IVUS use and operator experience.

"For PCI in complex lesions, both the use of IVUS and operator’s lifetime experience to guide the procedure appear to positively impact patients 10 years down the line, with less target-vessel MI and cardiac death," the researchers wrote. "The beneficial effects of IVUS were more pronounced in less experienced operators."

"Overall, these results suggest that IVUS guidance can partially offset the detriment of inexperience,” the researchers concluded.

Reference:

Choi KH, Lee SY, Song YB, Park TK, Lee JM, Yang JH, Choi JH, Choi SH, Gwon HC, Hahn JY. Prognostic Impact of Operator Experience and IVUS Guidance on Long-Term Clinical Outcomes After Complex PCI. JACC Cardiovasc Interv. 2023 Jul 24;16(14):1746-1758. doi: 10.1016/j.jcin.2023.04.022. PMID: 37495350.