E-9 | Intravascular Ultrasound Guided Percutaneous Coronary Intervention for Complex Calcified Lesion Requiring Rotational Atherectomy

Intravascular ultrasound (IVUS) is a very useful tool for accurate lesion assessment and optimal stent implantation in complex coronary intervention. We sought to evaluate the impact of IVUS guidance on percutaneous coronary intervention (PCI) using rotational atherectomy (RA) for complex calcified lesion. Five-hundred fourteen patients with calcified coronary artery disease who underwent PCI using RA and second-generation drug-eluting stent between January 2010 and October 2019 at 9 tertiary centers, from the ‘ROtational atherectomy in Calcified lesions in Korea (ROCK)’ registry, were included in this study. Primary endpoint was a composite of cardiac death, myocardial infarction or target vessel revascularization. Secondary endpoints included individual components of primary endpoint. Among the overall study population, IVUS was used in 242 patients (47.1%) during complex PCI using RA. The IVUS-guided PCI group had higher prevalences of accompanying left main disease (23.7% vs. 5.9%; p < 0.001) and left anterior descending artery as a target vessel (77.6% vs 68.1%; p=0.023), and more frequent uses of adjunctive post-dilatation (88.0% vs. 73.8%; p < 0.001), dual antiplatelet therapy (99.6% vs 94.1%; p<0.001) and beta blocker (75.4% vs 66.9%; p=0.04) at discharge, compared with the angiography-guided PCI group. During a median follow-up of 20 [9-39] months, MACE rate was not significantly different between the two groups (19.1% vs. 31.4%; hazard ratio (HR): 0.855; 95% confidence interval (CI): 0.530 to 1.377; p = 0.519). However, IVUS-guided PCI was associated with a significantly lower risk of cardiac death or MI compared with angiography-guided PCI (9.6% vs. 23.5%; HR: 0.478; 95% CI: 0.253 to 0.904; p=0.02). Multivariate analysis showed that IVUS guidance was independently associated with a lower risk of cardiac death or MI (adjusted HR: 0.414, 95% CI: 0.198–0.862; p=0.019). IVUS guidance should be considered when performing PCI with RA for complex calcified lesion.