Impact of intravascular ultrasound for coronary bifurcations treated with last generations stents: insights from the BIFURCAT-ULTRA registry

• Published in: European heart journal. Quality of care & clinical outcomes 2024-11
• Main Authors: Bruno, Francesco, Choi, Ki Hong, De Filippo, Ovidio, Kim, Hyun Kuk, Doronzo, Mattia, Cho, Yun-Kyeong, Pinxterhuis, Tineke H, Kang, Jeehoon, Mattesini, Alessio, Song, Young Bin, Piccolo, Raffaele, Koo, Bon-Kwon, Wańha, Wojciech, Lee, Jong, Cortese, Bernardo, Gwon, Hyeon-Cheol, Perl, Leor, Kim, Hyo-Soo, Tuttolomondo, Domenico, Iannaccone, Mario, Chun, Woo Jung, Capodanno, Davide, Leone, Attilio, Giachet, Alessandra Truffa, Hur, Seung-Ho, Stefanini, Giulio, Han, Seung Hwan, Escaned, Javier, Carmeci, Antonino, Campo, Gianluca, Patti, Giuseppe, von Birgelen, Clemens, de Ferrari, Gaetano Maria, Nam, Chang-Wook, D'Ascenzo, Fabrizio
• Format: Article
• Language: English
• ISSN: 2058-5225; 2058-1742; 2058-1742
• DOI: 10.1093/ehjqcco/qcae091

Bifurcation lesions are associated with higher rates of major adverse cardiovascular events (MACE). To investigate the impact of imaging-guided PCI in a real-world population with coronary bifurcation lesions. From the ULTRA-BIFURCAT registry, we compared IVUS vs. angiographic guidance in a cohort of 3486 propensity matched patients. MACE a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization (TLR) and stent-thrombosis was the primary endpoint. Subgroup analyses were performed for unprotected left main (ULM) and non-ULM disease. PSM generated 1743 pairs. MACE occurred in 154 (9%) patients in the IVUS guided group and in 199 (11%) patients in the angio-guided group (p = 0.09). IVUS guidance was associated with lower MACE in the ULM population [HR 0.62, 95% CI 0.46-0.83], but had no impact in the non-ULM population [HR 1.12, 95% CI 0.83-1.51], p for interaction = 0.006. IVUS was associated with reduction in all-MI [HR 0.32, 95% CI 0.16-0.64] in the ULM population and with lower ST in the non-ULM population [HR 0.24, 95% CI 0.08-0.71]. Provisional stenting was associated with lower MACE in the ULM population [HR 0.67, 95% CI 0.45-0.98], whereas kissing balloon [HR 0.75, 95% CI 0.56-0.99] and ultra-thin stents [HR 0.44, 95% CI 0.29-0.67] were protective factors in the non-ULM population. In a real-world scenario, IVUS guidance during DES implantation is associated with a lower rate of MACE in patients with ULM coronary bifurcation lesions. In non-ULM bifurcations, no difference was observed on MACE, while IVUS guidance was associated with a lower rate of ST.