Clinical outcomes of post-stent intravascular ultrasound examination for chronic total occlusion intervention with drug-eluting stents.

Background Few studies have evaluated intravascular ultrasound (IVUS) use in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Aims In CTO-PCI, we aimed to (1) evaluate the clinical benefits of performing post-stent IVUS in preventing adverse clinical events, and (2) identify IVUS parameters and cut-off values for prediction of target-lesion revascularization (TLR)/reocclusion. Methods A total of 1,077 patients with 1077 CTO lesions treated with drug-eluting stents (DES) were included. Clinical outcomes during a median follow-up of 6.3 years were compared between subjects with or without post-stent IVUS using the inverse probability weighting method. Results Of 1,077 patients, post-stent IVUS was performed in 838 (77.8%) cases while the remaining 239 (22.2%) cases did not undergo. In the weighted population, the risk of TLR/reocclusion was significantly lower in subjects with post-stent IVUS (9.6% vs. 18.9%, hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.34-0.86, P=0.01), compared with those without post-stent IVUS. Cox-regression analysis showed that minimal stent area (MSA) measured by IVUS was the only parameter independently associated with TLR/reocculsion (HR, 0.78; 95% CI 0.64-0.95; P=0.01) and the optimal MSA cut-off value was 4.9 mm2 for prediction of TLR/reocclusion (area under the curve=0.632, P=0.001). Conclusions In CTO-PCI with DES, post-stent IVUS evaluation was associated with a lower risk of TLR/reocclusion. The final MSA was independently associated with TLR/reocclusion with a cut-off value of 4.9 mm2.