Major adverse cardiac events risk low after new-generation stent implantation
medwireNews: A meta-analysis designed to compare hard outcomes after intravascular ultrasound (IVUS)- versus angiography-guided stent implantation highlights the very low risk of major adverse cardiac events (MACE) among patients receiving new-generation drug-eluting stents (DES).
In their meta-analysis using individual patient-level data, Myeong-Ki Hong (Severance Cardiovascular Hospital, Seoul, Korea) and co-authors found a significant 64% relative risk reduction in the hard MACE endpoint – a composite of cardiac death, myocardial infarction and stent thrombosis – at 1 year after IVUS- versus angiography-guided DES implantation.
However, the risk reduction, reported in JACC Cardiovascular Interventions, was based on very low overall rates. In an accompanying commentary, Harold Dauerman (University of Vermont Medical Center, Burlington, USA) notes that clinical practice guidelines are unlikely to recommend routine IVUS guidance for high-risk percutaneous coronary intervention (PCI) as a result of these findings, due to the “strikingly low event rates for the no longer high-risk lesions in the meta-analysis”.
Out of 2345 patients undergoing high-risk PCI, the hard MACE endpoint occurred in just five (0.4%) patients in the IVUS group and 14 (1.2%) in the angiography group.
Nevertheless, Dauerman suggests that the possible improvement in hard MACE outcomes with IVUS-guided stent implantation, combined with extensive experience of its use, “may be enough to rewrite the PCI guidelines strongly in favor of the selected use of intracoronary imaging”.
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016