Journal Article

Long-term outcomes of intravascular ultrasound-guided percutaneous coronary intervention versus coronary artery bypass grafting for multivessel coronary artery disease

Min-Ju, Kim, Tresukosol, Damras, Lee, Jinho, Huang, He, Kim, Hoyun, Seung-Jung, Park, Ong, Tiong Kiam, Myung-Ho, Jeong, Hun-Jun Park, Young-Hyo, Lim, Kim, Byung Ok, Do-Yoon, Kang, Ahn, Sung Gyun, Choi, Yeonwoo, Seung Ho Hur, Jung-Min, Ahn, Kang, Woong Chol, Bong-Ki, Lee, Duk-Woo, Park, Seung-Woon Rha, Do-Sun, Lim, Cheol-Hyun Chung, Sangyong Jo, Hyuck Moon Kwon, Jang Ho Bae

2025

Overview

BackgroundIntravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown to improve outcomes in complex coronary artery disease compared with angiography-guided PCI. However, long-term comparisons between IVUS-guided PCI and coronary artery bypass grafting (CABG) for multivessel disease (MVD) remain limited.MethodsThis post hoc analysis of the Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment Extended Follow-up study included 880 patients with MVD, excluding 15 patients who received medical therapy. Patients were categorised into IVUS-guided PCI (n=333), angiography-guided PCI (n=131) and CABG (n=401). The primary endpoint was the composite of death, myocardial infarction (MI) or target-vessel revascularisation over a median follow-up of 11.8 years.ResultsThe IVUS-guided PCI group showed no difference in the primary endpoint compared with CABG (adjusted HR 1.013; 95% CI 0.747 to 1.374; p=0.93). In contrast, angiography-guided PCI was associated with a higher risk of clinical events (adjusted HR 2.231; 95% CI 1.582 to 3.145; p<0.001). The safety endpoint (composite of death, MI and stroke) did not differ between IVUS-guided PCI and CABG (adjusted HR 0.845; 95% CI 0.605 to 1.181; p=0.324), while angiography-guided PCI was associated with a higher risk (adjusted HR 2.016; 95% CI 1.405 to 2.895; p<0.001). Both PCI groups had higher rates of repeat revascularisation compared with CABG.ConclusionsIVUS-guided PCI demonstrated comparable long-term outcomes to CABG in terms of mortality and safety endpoints, supporting its use in the treatment of MVD. These findings highlight the potential benefits of IVUS guidance in complex PCI procedures.Trial registration numbersNCT05125367 and NCT00997828.

• Publisher: BMJ Publishing Group LTD
• Subject: Angioplasty / Cardiovascular disease / Clinical outcomes / Coronary vessels / Heart attacks / Heart surgery / Medical imaging / Sensitivity analysis / Stents / Stroke / Survival analysis / Ultrasonic imaging / Vein & artery diseases