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The clinical utility of intravascular ultrasonography (IVUS)-guided therapy for small-vessel coronary lesion associated with type-2 diabetes mellitus [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-77009 | DOI: 10.14744/AnatolJCardiol.2019.77009  

The clinical utility of intravascular ultrasonography (IVUS)-guided therapy for small-vessel coronary lesion associated with type-2 diabetes mellitus

Lin Li1, Li Wang1, Chun-Juan Zhai1, Ya-ru Mou1, Jian-Hong Wang2, Lian-Qun Cui1
1Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University,China
2Department of hematology,Shandong Provincial Hospital affiliated to Shandong University,China

Objective: It is unknown if intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) should be routinely endorsed in small-vessel coronary lesion with type-2 diabetes mellitus(T2DM).This study aimed to assess the clinical significance of IVUS-guided PCI treatment for small-vessel coronary lesion with T2DM. Methods: This was a prospective interventional trial. A total of 228 type-2 diabetic patients with stable angina and positive stress test in the presence of coronary arteriography(CAG) involving small-vessel (online measurement reference vessel diameter ≤ 3.0 mm by means of quantitative coronary angiography QCA) were recruited who were divided into two groups: an IVUS-guided group (n = 120) and a CAG-guided group (n=108). Follow-up PCIs were performed via CAG or IVUS criteria respectively. Between-group comparisons were made for the number of stents implanted, length, diameter and high-pressure balloons used during post-dilatation. Major adverse cardiac events (MACE) which were defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization)(TLR) were the primary endpoint. Value of late lumen loss and proportion of in-stent restenosis(ISR) were the secondary endpoint, all of which were also evaluated during follow-up period. Results: There was an increased lesion length observed using the IVUS measurement when compared with QCA measurements in IVUS-guided group (P≤ 0.001). The number of implanted stents, diameter, length, percentage of high-pressure balloons used during post-dilatation, value of late lumen loss and proportion of ISR decreased in IVUS-guided group when compared with the CAG-guided group (P = 0.002, P = 0.001, P = 0.003, P = 0.004, P = 0.007, P = 0.001). After a two-year follow-up, Kaplan–Meier curves indicated that the incidence of MACE was significantly lower in the IVUS-guided group (P = 0.029), mainly because of reduction of TLR(P = 0.037).
Conclusions: IVUS-guided PCI treatment improved event-free survival in small-vessel coronary lesion with T2DM.

Keywords: Intravascular ultrasound, Type-2 diabetes mellitus, coronary artery disease, small-vessel disease




Corresponding Author: Lian-Qun Cui, China


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