Exploring The Efficacy Of Intravascular Ultrasound-Guided Interventions For Left Main Coronary Bifurcation Lesions

Objective : In recent years,with the gradual progress of intracoronary imaging,it has compensated for the inadequacy of angiography to guide interventional treatment.Intravascular ultrasound(IVUS),as an intravascular imaging technique,can provide the operator with more information about the lumen and wall,which can help to better guide interventional treatment.Several randomized controlled studies have demonstrated that IVUS-guided percutaneous coronary intervention can improve patient prognosis,but few studies have been performed on left main coronary bifurcation lesions.The aim of this study was to compare the efficacy of coronary angiography(CAG)alone with that of IVUS-guided left main coronary bifurcation lesions and to provide a scientific basis for the clinical application of IVUS.Methods:(1)A total of 113 patients who presented to the Affiliated Hospital of Inner Mongolia Medical University from June 2013 to September 2021 with CAG confirmed left main coronary bifurcation lesions and underwent percutaneous coronary intervention were retrospectively analyzed,and were divided into IVUS group(41 patients)and CAG group(72patients)according to whether they received IVUS examination or not to collect and compare the baseline data of each group.(2)113 patients with left main coronary bifurcation lesions were divided into a single-stent group(85 patients)and a double-stent group(28 patients)according to the intraoperative stenting procedure,and the lesion characteristics and procedure-related data were compared between patients who underwent IVUS and those who underwent angiography alone in the single-stent and double-stent groups,respectively.(3)Comparison of endpoint events in the IVUS and CAG groups at 12 months of follow-up.Results:Baseline information was similar and comparable between the two groups of patients.(1)In the single-stent group,the main branch stent diameter [3.75(3.50,4.00)mm vs.3.00(3.00,3.50)mm,P< 0.001] and the maximum balloon diameter [4.00(3.50,4.00)mm vs.3.00(3.00,3.50)mm,P< 0.001] were greater in the IVUS group than in the CAG group;In the double-stent group,the main branch stent diameter [3.50(3.50,4.00)mm vs.3.50(3.00,3.50)mm,P< 0.032] and the maximum balloon diameter [4.00(4.00,4.00)mm vs.3.50(3.50,4.00)mm,P< 0.016] were greater in the IVUS group than in the CAG group.(2)In the single-stent group,the patients in the IVUS group had a greater minimum lumen diameter(MLD)(3.83±0.23 mm vs.3.65±0.33 mm,P=0.010)in the immediate postoperative period at the distal left main stem and a greater MLD(3.17±0.31 mm vs.2.93±0.37 mm,P=0.004)in the immediate postoperative period at the left anterior descending branch opening than in the CAG group.In the double-stent group,the patients in the IVUS group also had a greater minimum lumen diameter(MLD)in the immediate postoperative period at the distal left main stem(3.69±0.25 mm vs.3.47±0.28 mm,P=0.044),a greater MLD in the immediate postoperative period at the opening of the anterior descending branch(3.03±0.19 mm vs.2.83±0.27 mm,P=0.045)and a greater MLD in the immediate postoperative period at the opening of the left circumflex branch(2.66±0.22 mm vs.2.41±0.33 mm,P=0.035)than in the CAG group.(3)The 12-month follow-up showed that the incidence of major adverse cardiac events(MACE)was lower in the IVUS group than in the CAG group(7.3% vs.22.2%,P=0.041).Among them,myocardial infarction(2.4% vs.4.2%),revascularization(4.9% vs.12.5%),target lesion revascularization(2.4% vs.8.3%),Cardiac death(0% vs.1.4%),recurrent angina(4.9% vs.16.7%),and in-stent restenosis(2.4% vs.6.9%)were lower in the IVUS group than in the CAG group,but none of the differences were statistically significant(P > 0.05).(4)The risk of MACE increased with age,with a statistically significant difference(OR=1.097,95% CI:1.017～1.182,P=0.016).Diabetes increased the risk of MACE,with a statistically significant difference(OR=3.686,95% CI:1.252～10.854,P=0.018).Conclusions:(1)Compared with CAG alone,IVUS can help the operator to more accurately assess the lesion,select the appropriate balloon and stent size,and thus achieve greater immediate postoperative MLD and optimize the stent implantation process,making IVUS an important adjunct to guide interventional treatment of left main coronary bifurcation lesions.(2)IVUS-guided interventions for left main coronary bifurcation lesions are safe and effective,and can reduce MACE and help improve patient prognosis.(3)Advanced age and diabetes mellitus are independent risk factors for left main coronary bifurcation lesions.