ORIGINAL PAPER Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry Giuseppe Biondi-Zoccai • Imad Sheiban • Enrico Romagnoli • Stefano De Servi • Corrado Tamburino • Antonio Colombo • Francesco Burzotta • Patrizia Presbitero • Leonardo Bolognese • Leonardo Paloscia • Paolo Rubino • Gennaro Sardella • Carlo Briguori • Luigi Niccoli • Gianfranco Franco • Domenico Di Girolamo • Luigi Piatti • Cesare Greco • Davide Capodanno • Giuseppe Sangiorgi Received: 23 December 2010 / Accepted: 9 June 2011 / Published online: 24 June 2011 Ó Springer-Verlag 2011 Abstract Background Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. Methods A multicenter, retrospective study was con- ducted enrolling consecutive patients undergoing bifurca- tion PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocar- dial infarction or target lesion revascularization (TLR)]. Results A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p [ 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p [ 0.05). Even at multivariable Cox proportional hazard analysis with propensity score For the Italian Multicenter Registry on Bifurcation Study (I-BIGIS) Group. G. Biondi-Zoccai (&) Division of Cardiology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy e-mail: gbiondizoccai@gmail.com I. Sheiban Division of Cardiology, University of Turin, Turin, Italy E. Romagnoli Division of Cardiology, Policlinico Casilino, Rome, Italy A. Colombo Interventional Cardiology, San Raffaele Institute, and EMO-GVM Centro Cuore Columbus, Milan, Italy S. De Servi Dipartimento Cardiovascolare, Ospedale di Legnano, Milan, Italy C. Tamburino Á D. Capodanno Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy F. Burzotta Institute of Cardiology, Catholic University, Rome, Italy P. Presbitero Division of Cardiology, Istituto Clinico Humanitas, Rozzano, Milan, Italy L. Bolognese Cardiovascular Department, San Donato Hospital, Arezzo, Italy L. Paloscia Interventional Cardiology, Santo Spirito Hospital, Pescara, Italy P. Rubino Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy G. Sardella Cardiovascular Sciences, Policlinico Umberto I, Rome, Italy C. Briguori Division of Cardiology, Clinica Mediterranea, Naples, Italy L. Niccoli Interventional Cardiology, Spedali Civili, Brescia, Italy G. Franco Interventional Cardiology, Mater Salutis Hospital, Legnago, Italy 123 Clin Res Cardiol (2011) 100:1021–1028 DOI 10.1007/s00392-011-0336-x