Publikation

Impact of intracoronary ultrasound guidance on long-term outcome of percutaneous coronary interventions in diabetics--insights from the randomized SIPS trial

Wissenschaftlicher Artikel/Review - 01.06.2002

Bereiche
PubMed
DOI

Zitation
Mueller C, Mc Hodgson J, Brutsche M, Perruchoud A, Marsch S, Hunziker P, Buettner H. Impact of intracoronary ultrasound guidance on long-term outcome of percutaneous coronary interventions in diabetics--insights from the randomized SIPS trial. Swiss medical weekly : official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 2002; 132:279-84.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
Swiss medical weekly : official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 2002; 132
Veröffentlichungsdatum
01.06.2002
ISSN (Druck)
1424-7860
Seiten
279-84
Kurzbeschreibung/Zielsetzung

BACKGROUND: The Strategy for Intravascular ultrasound (IVUS) guided PTCA and Stenting (SIPS) trial included a prospectively designed subgroup analysis to investigate whether routine IVUS-guidance during percutaneous intervention improves long-term outcome in diabetics. METHODS AND RESULTS: Consecutive diabetic patients (n = 43) with 57 lesions were randomly assigned to receive provisional stenting with angiographic guidance only (ANGIO) or with IVUS guidance provided by a combined IVUS/variable diameter balloon catheter (IVUS). The combined primary endpoint included death, nonfatal myocardial infarction and target vessel revascularisation (TVR) and was recorded for 28 months. The re-stenosis rate at 6-month follow-up angiography was defined as a secondary endpoint. A primary endpoint occurred in 6 diabetic patients (31.6%) in the IVUS-group and 11 diabetic patients (45.8%) in the ANGIO-group (relative risk for IVUS, 0.83, 95% confidence interval 0.28-2.35, p = 0.83). Kaplan-Meier analysis suggested that IVUS did slightly attenuate the negative effect of diabetes on long-term event-free survival. The quantitative assessment of follow-up angiography revealed that the incidence of re-stenosis was high in both groups (IVUS: 53% versus ANGIO: 52%, p = 0.94). There was no difference in the mean duration of hospitalisation (11.8 days with IVUS versus 11.2 days with ANGIO, p = 0.83) or total cost (US dollars 16,725 with IVUS versus US dollars 16,230 with ANGIO, p = 0.83) during follow-up. CONCLUSION: Routine IVUS-guidance during provisional stenting seems to slightly attenuate the negative effect of diabetes on long-term outcome. However, the re-stenosis rate remains very high.