The Clinical Application Of Intravascular Ultrasound During Percutaneous Coronary Intervention For Left Main Coronary Disease

Objective : This study sought to evaluate the clincal impact of the use of intravascular ultrasound during percutaneous coronary intervention of patients with left main coronary disease.and to investigate clinical outcome of IVUS-guided stent implantation for left main coronary disease contained vulnerable plaque.Methods : A total of 76 patients with left main coronary disease who underwent stent implantation from January 2012 to January 2016 under the guidance of IVUS(29 patients)or conventional angiography(47 patients)were registered in our hostipal.The IVUS-guided group was divided into two subgroups.The patients(12 patients)who contained vulnerable plaque which was confirmed by VH-IVUS were registered in the vulnerable plaque group.The patients(17 patients)who did not contain vulnerable plaque were registered in the non-vulnerable plaque group.The primary endpoint of this study was the rate of one–year the major adverse cardiac events(MACE,including cardiac death,myocardial infarction,and target vessel revascularization).The aim is to compare the rate of one–year the primary endpoint events between two groups and to compare the rate between two subgroups.Results:There was a tendency of lower risk of one-year the major adverse cardiacevents with IVUS guidance compared with angiography guidance(6.9% versus 19.1%,log-rank P=0.072).There was also a tendency of lower risk of one-year mortality rate with IVUS guidance compared with angiography guidance(0.0% versus 8.5%,log-rankP=0.080).The risk of myocardial infarction or target vessel revascularization was not associated with the use of IVUS guidance(0.0% versus 2.1%,log-rank P=0.355;6.9%versus 10.6%,log-rank P=0.347).The one-year MACE rates were similar between the vulnerable plaque group and the non-vulnerable plaque group(8.3% versus 5.9%,log-rank P=0.702).Conclusion : Percutaneous coronary intervention with IVUS guidance presented a decreasing tendency of the one-year MACE rate for left main coronary disease when compared with conventional angiography guidance.IVUS guidance probably decreased the mortality rate to optimize the outcomes and it was worth of clinical promotion.Compared with non-vulnerable plaque group,IVUS guidance did not increase the risk of the one-year MACE in vulnerable plaque group.