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이달의 kcj Hot Article / 2026년 9월
Intravascular Ultrasound-Guided Percutaneous Coronary Intervention for Severely Calcified Lesions Requiring Rotational Atherectomy
저자 Duck-Hyun Jang, MD,1,* Je Sang Kim, MD,1,* Sung-Ho Her, MD, PhD,2,† Kyusup Lee, MD,3 Sang-Hoon Cho, PhD,4 Ik-Jun Choi, MD, PhD,5 Jae-Hwan Lee, MD, PhD,6 Jang-Hoon Lee, MD, PhD,7 Sang-Rok Lee, MD, PhD,8 Pil-Hyung Lee, MD, PhD,9 Seung-Whan Lee, MD, PhD,9 Ki-Dong Yoo, MD, PhD,2 Kyeong Ho Yun, MD, PhD,10 Young Jin Choi, MD, PhD,1 Tae-Hoon Kim, MD, PhD,1,11 Ho-Jun Jang, MD,1,11 Ha Wook Park, MD,1 Chi-Hoon Kim, MD,1 and Hyun-Jong Lee, MD, PhD1,†
소속 1 Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea. 2 Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 3 Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 4 Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea. 5 Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. 6 Department of Cardiology in Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea. 7 Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea. 8 Department of Cardiology, Chonbuk National University Hospital, Jeonju, Korea. 9 Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 10 Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea. 11 Department of Cardiology, Hanil General Hospital, Seoul, Korea.

Background and Objectives

Intravascular ultrasound (IVUS) is an invaluable tool for accurate lesion assessment and optimal stent implantation during complex coronary interventions. This study evaluated the impact of IVUS guidance on the long-term clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) for severely calcified lesions requiring rotational atherectomy (RA).

Methods

Between January 2010 and October 2019, 511 patients from nine tertiary centers in South Korea who underwent PCI with RA using second-generation drug-eluting stents were enrolled. The primary endpoint was a composite of cardiac death or myocardial infarction (MI).

Results

IVUS was performed in 241 (47.2%) patients. Compared with the angiography-guided PCI (A-GP) group, the IVUS-guided PCI (I-GP) group had a higher prevalence of the left main disease (23.7% vs. 5.9%; p<0.001), larger stents (3.1 mm vs. 2.9 mm; p<0.001), longer stents (72 mm vs. 61 mm; p<0.001), and more frequent post-dilation (85.4% vs. 71.9%; p<0.001). Within a median follow-up of 20 (9–39) months, compared with the A-GP group, the I-GP group had a significantly lower risk of cardiac death or MI (7.0% vs. 11.2%; hazard ratio [HR], 0.481; 95% confidence interval [CI], 0.254–0.908; p=0.024). After adjusting for potential confounders with inverse probability of treatment weighting, the I-GP group still had a significantly lower risk of cardiac death or MI, and cardiac death (HR, 0.442; 95% CI, 0.226–0.865; p=0.017, and HR, 0.413; 95% CI, 0.181–0.944; p=0.036).

Conclusions

IVUS guidance is likely to improve long-term clinical outcomes in patients undergoing PCI with RA for severely calcified lesions.
첨부파일1 kcj-56-776-abf001.jpg kcj-56-776-abf001.jpg (다운 6회)
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