***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Prior small to modest-sized studies suggest a benefit of intravascular ultrasound ( IVUS ) guidance in noncomplex lesions . Whether IVUS guidance is associated with improved clinical outcomes after  drug-eluting stent ( DES ) implantation  in an unrestricted patient population is unknown . Methods and Results — Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents ( ADAPT-DES ) was a prospect i ve , multicenter , nonr and omized “ all-comers ” study of 8583 consecutive patients at 11 international centers design ed to determine the frequency , timing , and correlates of stent thrombosis and adverse clinical events after DES . Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes . IVUS was utilized in 3349 patients ( 39 % ) , and larger-diameter devices , longer stents , and /or higher inflation pressures were used in 74 % of IVUS-guided cases . IVUS guidance compared with angiography guidance was associated with reduced 1-year rates of definite/probable stent thrombosis ( 0.6 % [ 18 events ] versus 1.0 % [ 53 events ] ; adjusted hazard radio , 0.40 ; 95 % confidence interval , 0.21–0.73 ; P=0.003 ) , myocardial infa rct ion ( 2.5 % versus 3.7 % ; adjusted hazard radio , 0.66 ; 95 % confidence interval , 0.49–0.88 ; P=0.004 ) , and composite adjudicated major adverse cardiac events ( ie , cardiac death , myocardial infa rct ion , or stent thrombosis ) ( 3.1 % versus 4.7 % ; adjusted hazard radio , 0.70 ; 95 % confidence interval , 0.55–0.88 ; P=0.002 ) . The benefits of IVUS were especially evident in patients with acute coronary syndromes and complex lesions , although significant reductions in major adverse cardiac events were present in all patient subgroups those with including stable angina and single-vessel disease . Conclusions — In ADAPT-DES , the largest study of IVUS use to date , IVUS guidance was associated with a reduction in stent thrombosis , myocardial infa rct ion , and major adverse cardiac events within 1 year after DES implantation . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00638794 OBJECTIVES This study sought to assess the impact of intravascular ultrasound ( IVUS ) guidance on clinical outcomes following drug-eluting stent implantation when treating long lesions . BACKGROUND The role of IVUS guidance when treating long lesions has been tested during bare-metal stent , but not during drug-eluting stent , implantation . METHODS A total of 543 patients treated with stents ≥ 28 mm in length were r and omly assigned to IVUS guidance ( n = 269 ) versus angiography guidance ( n = 274 ) . The primary endpoint was a composite of major adverse cardiac events ( MACE ) , including cardiovascular death , myocardial infa rct ion , target vessel revascularization , or stent thrombosis at 1 year following intervention . RESULTS In the intention-to-treat analysis , total stent length was 32.4 mm in the IVUS-guided arm versus 32.3 mm in angiography-guided arm ( p = 0.84 ) . Adjunct post-dilation was more frequently performed in the IVUS-guided arm ( 54.6 % vs. 44.5 % , p = 0.03 ) ; post-intervention minimal lumen diameters were similar ( 2.55 vs. 2.55 mm , respectively , p = 0.50 ) ; and MACE occurred in 12 ( 4.5 % ) patients in IVUS-guided arm and in 20 ( 7.3 % ) patients in the angiography-guided arm ( p = 0.16 ) . However , among the 269 patients assigned to  IVUS guidance , IVUS was not used in 13 patients ( 4.8 % ) ; conversely , in 274 patients assigned to angiography alone , 41 patients ( 15.0 % ) were treated with IVUS guidance . Therefore , in a per- protocol analysis according to actual IVUS usage , minimum lumen diameter was larger ( 2.58 vs. 2.51 mm , p = 0.04 ) , and MACE rates were lower : 4.0 % in the IVUS-guided arm versus 8.1 % in the angiography-guided arm ( p = 0.048 ) . CONCLUSIONS A strategy of routine IVUS for drug-eluting stent implantation in long lesions did not improve the 1-year MACE rates . The IVUS use per operator decision was associated with improved results . ( A New Strategy Regarding Discontinuation of Dual Antiplatelet ; NCT01145079 ) BACKGROUND No r and omized studies have thus far evaluated intravascular ultrasound ( IVUS ) guidance in the drug-eluting stent ( DES ) era . The aim was to evaluate if IVUS optimized DES implantation was superior to angiographic guidance alone in complex lesions . METHODS R and omized , multicentre , international , open label , investigator-driven study evaluating IVUS vs angiographically guided DES implantation in patients with complex lesions ( defined as bifurcations , long lesions , chronic total occlusions or small vessels ) . Primary study endpoint was post-procedure in lesion minimal lumen diameter . Secondary end points were combined major adverse cardiac events ( MACE ) , target lesion revascularization , target vessel revascularization , myocardial infa rct ion ( MI ) , and stent thrombosis at 1 , 6 , 9 , 12 , and 24 months . RESULTS The study included 284 patients . No significant differences were observed in baseline characteristics . The primary study end point showed a statistically significant difference in favor of the IVUS group ( 2.70 mm ± 0.46 mm vs. 2.51 ± 0.46 mm ; P = .0002 ) . During hospitalization , no patient died , had repeated revascularization , or a Q-wave MI . No difference was observed in the occurrence of non-Q wave MI ( 6.3 % in IVUS vs. 7.0 % in angio-guided group ) . At 24-months clinical follow-up , no differences were still observed in cumulative MACE ( 16.9%vs . 23.2 % ) , cardiac death ( 0%vs . 1.4 % ) , MI ( 7.0%vs . 8.5 % ) , target lesion revascularization ( 9.2 % vs. 11.9 % ) or target vessel revascularization ( 9.8 % vs. 15.5 % ) , respectively in the IVUS vs. angio-guided groups . In total , only one definite subacute stent thrombosis occurred in the IVUS group . CONCLUSIONS A benefit of IVUS optimized DES implantation was observed in complex lesions in the post-procedure minimal lumen diameter . No statistically significant difference was found in MACE up to 24 months Background The importance of intravascular ultrasound (IVUS)-guided stenting of the unprotected left main coronary artery ( ULMCA ) remains controversial and has not been fully studied in the subset of patients with ULMCA . This study evaluated the clinical outcome of IVUS-guided stenting using a drug-eluting stent for ULMCA . Methods A total of 1,016 consecutive patients with ULMCA stenosis who underwent drug-eluting stent implantation from January 2006 to December 2011 were prospect ively registered . The primary endpoint of this nonr and omized registry was the rate of one-year major adverse cardiac events ( MACE , including cardiac death , myocardial infa rct ion , and target vessel revascularization ) . Stent thrombosis served as the safety endpoint . Propensity score matching was used to calculate the adjusted event rate . Results The unadjusted one-year MACE rate was 14.8 % in the IVUS-guided group ( n=337 , 33.2 % ) , significantly different from the 27.7 % ( P<0.001 ) in the angiography-guided group ( n=679 , 66.8 % ) . After propensity score matching , 291 paired patients were matched between the two groups , and the difference in one-year MACE between IVUS-guided ( 16.2 % ) versus angiography-guided ( 24.4 % ) groups was still significant ( P=0.014 ) , mainly driven by decreased rates of cardiac death ( 1.7 % ) and target vessel revascularization ( 3.4 % ) in the IVUS-guided group when compared with 5.2 % ( P=0.023 ) and 10.0 % ( P=0.002 ) in the angiography-guided group , respectively . Although it did not reach significance ( P=0.075 ) , the adjusted one-year rate of stent thrombosis in the angiography-guided group was higher than in the IVUS-guided group . Conclusion Compared with angiography guidance , IVUS-guided treatment of ULMCA using a drug-eluting stent was associated with a significant reduction of one-year cardiac death and target vessel revascularization , result ing in less frequent one-year MACE after propensity score matching OBJECTIVES This study sought to report the final 5 years follow-up of the l and mark LEADERS ( Limus Eluted From A Durable Versus ERodable Stent Coating ) trial . BACKGROUND The LEADERS trial is the first r and omized study to evaluate biodegradable polymer-based drug-eluting stents ( DES ) against durable polymer DES . METHODS The LEADERS trial was a 10-center , assessor-blind , noninferiority , " all-comers " trial ( N = 1,707 ) . All patients were central ly r and omized to treatment with either biodegradable polymer biolimus-eluting stents ( BES ) ( n = 857 ) or  durable polymer sirolimus-eluting stents ( SES ) ( n = 850 ) . The primary endpoint was a composite of cardiac death , myocardial infa rct ion ( MI ) , or clinical ly indicated target vessel revascularization within 9 months . Secondary endpoints included extending the primary endpoint to 5 years and stent thrombosis ( ST ) ( Academic Research Consortium definition ) . Analysis was by intention to treat . RESULTS At 5 years , the BES was noninferior to SES for the primary endpoint ( 186 [ 22.3 % ] vs. 216 [ 26.1 % ] , rate ratio [ RR ] : 0.83 [ 95 % confidence interval ( CI ) : 0.68 to 1.02 ] , p for noninferiority < 0.0001 , p for superiority = 0.069 ) . The BES was associated with a significant reduction in the more comprehensive patient-orientated composite endpoint of all-cause death , any MI , and all-cause revascularization ( 297 [ 35.1 % ] vs. 339 [ 40.4 % ] , RR : 0.84 [ 95 % CI : 0.71 to 0.98 ] , p for superiority = 0.023 ) . A significant reduction in very late definite ST from 1 to 5 years was evident with the BES ( n = 5 [ 0.7 % ] vs. n = 19 [ 2.5 % ] , RR : 0.26 [ 95 % CI : 0.10 to 0.68 ] , p = 0.003 ) , corresponding to a significant reduction in ST-associated clinical events ( primary endpoint ) over the same time period ( n = 3 of 749 vs. n = 14 of 738 , RR : 0.20 [ 95 % CI : 0.06 to 0.71 ] , p = 0.005 ) . CONCLUSIONS The safety benefit of the biodegradable polymer BES , compared with the durable polymer SES , was related to a significant reduction in very late ST ( > 1 year ) and associated composite clinical outcomes . ( Limus Eluted From A Durable Versus ERodable Stent Coating [ LEADERS ] trial ; NCT00389220 ) Objective : To assess the role of the intravascular ultrasound ( IVUS ) during implantation of Drug‐eluting stents ( DES ) on long‐term outcome in patients with complex coronary artery disease and high clinical risk profile with special attention to the development of late stent thrombosis ( LST ) . Methods : Two hunderd and ten patients were r and omly assigned to receive DES either with ( N = 105 ) or without ( N = 105 ) the IVUS guidance . Dual antiplatelet treatment was administered for 6 months in all patients . At 18‐month follow‐up , the rates of Major adverse cardiac events ( MACEs ) ( death , myocardial infa rct ion , and reintervention ) were assessed in both groups with special attention to possible LST . Stent thrombosis was classified according to Academic Research Consortium ( ARC ) . Results : At the 18‐month follow‐up , there was no significant difference between both groups regarding MACE ( 11 % vs. 12 % ; P = NS ) . Stent thrombosis has occurred in four patients ( 3.8 % ) in the group with and in 6 patients ( 5.7 % ; P = NS ) in the group without the IVUS guidance . Conclus 
    Output:
    
Conclusions IVUS guidance was associated with improved clinical outcomes , especially in patients with complex lesions admitted with ACS .