AJC：常规血管内超声引导的支架置入或无益

　　韩国一项研究表明，在实施药物洗脱支架（DES）置入时，常规血管内超声（IVUS）引导未能产生临床获益。论文于5月28日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项研究共纳入662例由IVUS引导和912例由血管造影引导行DES（长度≤24 mm）置入的患者。在短病变置入DES后1年时，评估IVUS预测主要不良心脏事件（MACE；心血管性死亡、心肌梗塞或靶血管血运重建）的价值。

　　结果显示，在IVUS引导组中，辅助后扩张更常被实施，并且干预后最小管腔直径更大（P<0.001）。IVUS和血管造影引导组分别有15例（2.3%）和19例（2.1%）患者出现MACE。在糖尿病亚组患者中，IVUS和血管造影引导组的MACE发生率分别为3.4%和1.7%。在急性冠脉综合征患者中相应发生率分别为1.1%和2.7%。在临床高危（急性冠脉综合征和糖尿病）患者中未能确认短病变中IVUS引导DES置入的临床获益。

Usefulness of Intravascular Ultrasound to Predict Outcomes in Short-Length Lesions Treated With Drug-Eluting Stents

Intravascular ultrasound (IVUS) offers tomographic images of the coronary artery, helping physicians to refine drug-eluting stent (DES) implantation in angiographically complex lesions. However, controversy exists regarding whether the routine use of IVUS in short-length lesions leads to improved clinical outcomes after DES implantation. Therefore, we evaluated the usefulness of IVUS in predicting major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction, or target vessel revascularization, at 1 year after DES implantation in short-length lesions. The present study was a subanalysis of the REal Safety and Efficacy of a 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation (RESET) study with different clinical outcome parameters. The study population consisted of 662 patients with IVUS guidance and 912 patients with angiography guidance who underwent DES implantation (stent length ≤24 mm). In the IVUS-guided group, adjuvant postdilation was more frequently performed (43.0% vs 34.6%, p <0.001), and the postintervention minimal lumen diameters were greater (2.88 ± 0.44 mm vs 2.72 ± 0.43 mm, p <0.001). MACE occurred in 15 IVUS-guided (2.3%) and 19 angiographically guided (2.1%) patients (p = 0.872). In a subset of patients with diabetes mellitus (n = 292), the MACE rate was 3.4% (n = 4) and 1.7% (n = 3) in the IVUS- and angiographically guided patients, respectively (p = 0.384). The MACE rate in the IVUS- and angiographically guided patients with acute coronary syndrome (n = 601) was 1.1% (n = 3) and 2.7% (n = 9), respectively (p = 0.194). The clinical benefits of IVUS-guided DES implantation compared with angiographically guided DES implantation in short-length lesions could not be confirmed even in patients with clinically high-risk presentations (acute coronary syndrome and diabetes mellitus). In conclusion, routine IVUS guidance does not provide clinical benefits when performing short-length DES implantation.