Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents

Two-year follow-up of the ADAPT-DES study

Akiko Maehara, Gary S. Mintz, Bernhard Witzenbichler, Giora Weisz, Franz Josef Neumann, Michael J. Rinaldi, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Bruce R. Brodie, Thomas D. Stuckey, Ernest L. Mazzaferri, Thomas McAndrew, Philippe Genereux, Roxana Mehran, Ajay J. Kirtane, Gregg W. Stone

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: In the large-scale ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), drug-eluting stent implantation with intravascular ultrasound (IVUS) guidance was associated with a reduction in 1-year rates of stent thrombosis, myocardial infarction (MI), and major adverse cardiac events (cardiac death, MI, or stent thrombosis) compared with angiography guidance alone. We assessed whether the benefits of IVUS guidance were maintained, reduced, or increased at 2 years. METHODS AND RESULTS: ADAPT-DES was a prospective, multicenter, nonrandomized all-comers study of 8582 consecutive patients at 11 US and German sites designed to determine the frequency, timing, and correlates of adverse events after drug-eluting stents. Propensity-adjusted multivariable analysis was performed to examine the impact of IVUS guidance on 2-year outcomes. IVUS guidance (n=3361; 39%) compared with angiography guidance (n=5221; 61%) was associated with reduced 2-year adjudicated rates of (1) major adverse cardiac events (cardiac death, MI, or stent thrombosis; 4.9% versus 7.5%; adjusted hazard ratio, 0.72; 95% CI, 0.59-0.89; P=0.003), (2) definite/probable stent thrombosis (0.55% versus 1.16%; adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P=0.003), and (3) MI (3.5% versus 5.6%; adjusted hazard ratio, 0.65; 95% CI, 0.51-0.83; P=0.0006). By landmark analysis, IVUS guidance compared with angiography guidance was also associated with significantly reduced rates of major adverse cardiac events, MI, stent thrombosis, and clinically driven target lesion revascularization between 1 and 2 years after drug-eluting stent implantation. The number needed to treat with IVUS guidance to prevent 1 major adverse cardiac event was reduced from 64 (42-137) at 1 year to 41 (29-69) at 2 years. CONCLUSIONS: In ADAPT-DES, the early improvement in event-free survival after drug-eluting stent implantation with IVUS guidance compared with angiography guidance was further increased with longer term follow-up to 2 years. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

Original languageEnglish (US)
Article numbere006243
JournalCirculation: Cardiovascular Interventions
Volume11
Issue number11
DOIs
StatePublished - Jan 1 2018

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Drug-Eluting Stents
Stents
Thrombosis
Myocardial Infarction
Angiography
Numbers Needed To Treat
Disease-Free Survival
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Maehara, Akiko ; Mintz, Gary S. ; Witzenbichler, Bernhard ; Weisz, Giora ; Neumann, Franz Josef ; Rinaldi, Michael J. ; Christopher Metzger, D. ; Henry, Timothy D. ; Cox, David A. ; Duffy, Peter L. ; Brodie, Bruce R. ; Stuckey, Thomas D. ; Mazzaferri, Ernest L. ; McAndrew, Thomas ; Genereux, Philippe ; Mehran, Roxana ; Kirtane, Ajay J. ; Stone, Gregg W. / Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents : Two-year follow-up of the ADAPT-DES study. In: Circulation: Cardiovascular Interventions. 2018 ; Vol. 11, No. 11.
@article{ff34be753d86429c96865c76c0168b19,
title = "Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: Two-year follow-up of the ADAPT-DES study",
abstract = "BACKGROUND: In the large-scale ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), drug-eluting stent implantation with intravascular ultrasound (IVUS) guidance was associated with a reduction in 1-year rates of stent thrombosis, myocardial infarction (MI), and major adverse cardiac events (cardiac death, MI, or stent thrombosis) compared with angiography guidance alone. We assessed whether the benefits of IVUS guidance were maintained, reduced, or increased at 2 years. METHODS AND RESULTS: ADAPT-DES was a prospective, multicenter, nonrandomized all-comers study of 8582 consecutive patients at 11 US and German sites designed to determine the frequency, timing, and correlates of adverse events after drug-eluting stents. Propensity-adjusted multivariable analysis was performed to examine the impact of IVUS guidance on 2-year outcomes. IVUS guidance (n=3361; 39{\%}) compared with angiography guidance (n=5221; 61{\%}) was associated with reduced 2-year adjudicated rates of (1) major adverse cardiac events (cardiac death, MI, or stent thrombosis; 4.9{\%} versus 7.5{\%}; adjusted hazard ratio, 0.72; 95{\%} CI, 0.59-0.89; P=0.003), (2) definite/probable stent thrombosis (0.55{\%} versus 1.16{\%}; adjusted hazard ratio, 0.40; 95{\%} CI, 0.22-0.73; P=0.003), and (3) MI (3.5{\%} versus 5.6{\%}; adjusted hazard ratio, 0.65; 95{\%} CI, 0.51-0.83; P=0.0006). By landmark analysis, IVUS guidance compared with angiography guidance was also associated with significantly reduced rates of major adverse cardiac events, MI, stent thrombosis, and clinically driven target lesion revascularization between 1 and 2 years after drug-eluting stent implantation. The number needed to treat with IVUS guidance to prevent 1 major adverse cardiac event was reduced from 64 (42-137) at 1 year to 41 (29-69) at 2 years. CONCLUSIONS: In ADAPT-DES, the early improvement in event-free survival after drug-eluting stent implantation with IVUS guidance compared with angiography guidance was further increased with longer term follow-up to 2 years. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.",
author = "Akiko Maehara and Mintz, {Gary S.} and Bernhard Witzenbichler and Giora Weisz and Neumann, {Franz Josef} and Rinaldi, {Michael J.} and {Christopher Metzger}, D. and Henry, {Timothy D.} and Cox, {David A.} and Duffy, {Peter L.} and Brodie, {Bruce R.} and Stuckey, {Thomas D.} and Mazzaferri, {Ernest L.} and Thomas McAndrew and Philippe Genereux and Roxana Mehran and Kirtane, {Ajay J.} and Stone, {Gregg W.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.117.006243",
language = "English (US)",
volume = "11",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
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number = "11",

}

Maehara, A, Mintz, GS, Witzenbichler, B, Weisz, G, Neumann, FJ, Rinaldi, MJ, Christopher Metzger, D, Henry, TD, Cox, DA, Duffy, PL, Brodie, BR, Stuckey, TD, Mazzaferri, EL, McAndrew, T, Genereux, P, Mehran, R, Kirtane, AJ & Stone, GW 2018, 'Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: Two-year follow-up of the ADAPT-DES study', Circulation: Cardiovascular Interventions, vol. 11, no. 11, e006243. https://doi.org/10.1161/CIRCINTERVENTIONS.117.006243

Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents : Two-year follow-up of the ADAPT-DES study. / Maehara, Akiko; Mintz, Gary S.; Witzenbichler, Bernhard; Weisz, Giora; Neumann, Franz Josef; Rinaldi, Michael J.; Christopher Metzger, D.; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Brodie, Bruce R.; Stuckey, Thomas D.; Mazzaferri, Ernest L.; McAndrew, Thomas; Genereux, Philippe; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 11, No. 11, e006243, 01.01.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents

T2 - Two-year follow-up of the ADAPT-DES study

AU - Maehara, Akiko

AU - Mintz, Gary S.

AU - Witzenbichler, Bernhard

AU - Weisz, Giora

AU - Neumann, Franz Josef

AU - Rinaldi, Michael J.

AU - Christopher Metzger, D.

AU - Henry, Timothy D.

AU - Cox, David A.

AU - Duffy, Peter L.

AU - Brodie, Bruce R.

AU - Stuckey, Thomas D.

AU - Mazzaferri, Ernest L.

AU - McAndrew, Thomas

AU - Genereux, Philippe

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: In the large-scale ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), drug-eluting stent implantation with intravascular ultrasound (IVUS) guidance was associated with a reduction in 1-year rates of stent thrombosis, myocardial infarction (MI), and major adverse cardiac events (cardiac death, MI, or stent thrombosis) compared with angiography guidance alone. We assessed whether the benefits of IVUS guidance were maintained, reduced, or increased at 2 years. METHODS AND RESULTS: ADAPT-DES was a prospective, multicenter, nonrandomized all-comers study of 8582 consecutive patients at 11 US and German sites designed to determine the frequency, timing, and correlates of adverse events after drug-eluting stents. Propensity-adjusted multivariable analysis was performed to examine the impact of IVUS guidance on 2-year outcomes. IVUS guidance (n=3361; 39%) compared with angiography guidance (n=5221; 61%) was associated with reduced 2-year adjudicated rates of (1) major adverse cardiac events (cardiac death, MI, or stent thrombosis; 4.9% versus 7.5%; adjusted hazard ratio, 0.72; 95% CI, 0.59-0.89; P=0.003), (2) definite/probable stent thrombosis (0.55% versus 1.16%; adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P=0.003), and (3) MI (3.5% versus 5.6%; adjusted hazard ratio, 0.65; 95% CI, 0.51-0.83; P=0.0006). By landmark analysis, IVUS guidance compared with angiography guidance was also associated with significantly reduced rates of major adverse cardiac events, MI, stent thrombosis, and clinically driven target lesion revascularization between 1 and 2 years after drug-eluting stent implantation. The number needed to treat with IVUS guidance to prevent 1 major adverse cardiac event was reduced from 64 (42-137) at 1 year to 41 (29-69) at 2 years. CONCLUSIONS: In ADAPT-DES, the early improvement in event-free survival after drug-eluting stent implantation with IVUS guidance compared with angiography guidance was further increased with longer term follow-up to 2 years. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

AB - BACKGROUND: In the large-scale ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), drug-eluting stent implantation with intravascular ultrasound (IVUS) guidance was associated with a reduction in 1-year rates of stent thrombosis, myocardial infarction (MI), and major adverse cardiac events (cardiac death, MI, or stent thrombosis) compared with angiography guidance alone. We assessed whether the benefits of IVUS guidance were maintained, reduced, or increased at 2 years. METHODS AND RESULTS: ADAPT-DES was a prospective, multicenter, nonrandomized all-comers study of 8582 consecutive patients at 11 US and German sites designed to determine the frequency, timing, and correlates of adverse events after drug-eluting stents. Propensity-adjusted multivariable analysis was performed to examine the impact of IVUS guidance on 2-year outcomes. IVUS guidance (n=3361; 39%) compared with angiography guidance (n=5221; 61%) was associated with reduced 2-year adjudicated rates of (1) major adverse cardiac events (cardiac death, MI, or stent thrombosis; 4.9% versus 7.5%; adjusted hazard ratio, 0.72; 95% CI, 0.59-0.89; P=0.003), (2) definite/probable stent thrombosis (0.55% versus 1.16%; adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P=0.003), and (3) MI (3.5% versus 5.6%; adjusted hazard ratio, 0.65; 95% CI, 0.51-0.83; P=0.0006). By landmark analysis, IVUS guidance compared with angiography guidance was also associated with significantly reduced rates of major adverse cardiac events, MI, stent thrombosis, and clinically driven target lesion revascularization between 1 and 2 years after drug-eluting stent implantation. The number needed to treat with IVUS guidance to prevent 1 major adverse cardiac event was reduced from 64 (42-137) at 1 year to 41 (29-69) at 2 years. CONCLUSIONS: In ADAPT-DES, the early improvement in event-free survival after drug-eluting stent implantation with IVUS guidance compared with angiography guidance was further increased with longer term follow-up to 2 years. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

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DO - 10.1161/CIRCINTERVENTIONS.117.006243

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