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Zebrauskaite A, Tsybulskyi E, Simanauskas I, Zebrauskaite G, Ziubryte G, Ordiene R, Unikas R, Jarusevicius G, Harding SA. Investigations of injection strategies to use heparinized normal saline instead of contrast media for intracoronary optical coherence tomography imaging. Perfusion 2024:2676591241264116. [PMID: 38907368 DOI: 10.1177/02676591241264116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND The benefits of intravascular imaging-guided percutaneous coronary interventions (PCI) are well established. Intravascular imaging guidance improves short- and long-term outcomes, especially in complex PCI. Optical coherence tomography (OCT) has a higher resolution than intravascular ultrasound. However, the usage of OCT is mainly limited by the need to use contrast for flushing injections, which increases the risk of contrast-induced acute kidney injury, especially in patients with underlying chronic kidney disease. The aim of this study was to prove that flushing techniques with normal saline instead of contrast can be used in OCT imaging and can generate high-quality images. METHODS This prospective single-center observational study included patients with indications for OCT-guided PCI. For OCT pullbacks, heparinized saline was injected by an automatic pump injector at different rates, and additional extension catheters for selective coronary artery engagement were used at the operator's discretion. Recordings were made using the Ilumien Optis OCT system (Abbott) and the Dragonfly (Abbott) catheter and were analyzed at 1-mm intervals by two operators. Pullbacks were categorized as having optimal, acceptable, or unacceptable imaging quality. A clinically usable run was determined if >75% of the region of interest length was described as having optimal or acceptable imaging quality. RESULTS A total of 32 patients were enrolled in the study; 47 different lesions were assessed before and after PCI. In total, 91.5% of runs were described as clinically suitable for use. CONCLUSION Heparinized saline injections for OCT imaging are effective in generating good-quality OCT images suitable for clinical use.
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Affiliation(s)
- Aiste Zebrauskaite
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eduard Tsybulskyi
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ignas Simanauskas
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gabriele Zebrauskaite
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Greta Ziubryte
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Kaunas, Lithuania
| | - Rasa Ordiene
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Ramunas Unikas
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gediminas Jarusevicius
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Kaunas, Lithuania
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Ashraf DA, Ahmed U, Khan ZZ, Mushtaq F, Bano S, Khan AR, Azam S, Haroon A, Malik SA, Aslam R, Kumar J, Khan FZ, Faheem A, Kumar S, Hassan S. Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis. Future Cardiol 2024; 20:137-150. [PMID: 38623957 PMCID: PMC11216519 DOI: 10.2217/fca-2023-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.
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Affiliation(s)
- Danish Ali Ashraf
- Department of Internal Medicine, Foundation University Medical College, Islamabad, 44000, Pakistan
| | - Usman Ahmed
- Department of Internal Medicine, Rawalpindi Medically University, Rawalpindi, 46000, Pakistan
| | - Zainab Zaib Khan
- Department of Internal Medicine, CMH Lahore Medical & Dental College, Lahore, 54810, Pakistan
| | - Fiza Mushtaq
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, 54700, Pakistan
| | - Shehar Bano
- Department of Internal Medicine, Gujranwala Medical College, Gujranwala, 52250, Pakistan
| | - Ali Raza Khan
- Department of Internal Medicine, Nishtar Medical University, Multan, 66000, Pakistan
| | - Saad Azam
- Department of Internal Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical & Dental College, Lahore, 64260, Pakistan
| | - Abdullah Haroon
- Department of Internal Medicine, Ziauddin Medical College, Karachi, 75600, Pakistan
| | - Salman Ahmed Malik
- Department of Internal Medicine, Nishtar Medical University, Multan, 66000, Pakistan
| | - Raza Aslam
- Department of Internal Medicine, Nishtar Medical University, Multan, 66000, Pakistan
| | - Jai Kumar
- Department of Internal Medicine, Wayne State School of Medicine, Detroit, MI 48201, USA
| | - Farva Zaib Khan
- Department of Internal Medicine, Al-Nafees Medical College, Islamabad, 44000, Pakistan
| | - Amna Faheem
- Department of Internal Medicine, Abbottabad Int. Medical College, Abbottabad, Pakistan
| | - Sarwan Kumar
- Department of Internal Medicine, Wayne State School of Medicine, Detroit, MI 48201, USA
| | - Saad Hassan
- Department of Internal Medicine, Foundation University Medical College, Islamabad, 44000, Pakistan
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Kimura T, Koeda Y, Ishida M, Numahata W, Yamaya S, Kikuchi S, Ishisone T, Goto I, Itoh T, Morino Y. Safety and feasibility of intravascular ultrasound-guided robotic percutaneous coronary intervention. Coron Artery Dis 2023; 34:463-469. [PMID: 37799042 DOI: 10.1097/mca.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Previous studies have demonstrated the benefit of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for preventing longitudinal geographic miss (LGM). However, it is yet unclear whether IVUS guidance is useful for robotic-PCI (robotic-assisted perctaneous coronary intervention [R-PCI]). METHODS A total of 58 consecutive patients with stable angina who underwent IVUS-guided R-PCI were enrolled. The stent landing position was angiographically marked using a balloon marker before stenting, followed by measurements of the expected stent length using balloon pullback. Subsequently, prestenting IVUS was performed to determine stent landing. All pre-PCI IVUS images were assessed for lesion length and percent plaque volume (%PV) using both IVUS and angiographic marking. LGM was defined as a residual %PV >50% at either the distal or proximal stent edge, any stent edge dissection, or additional stent deployment immediately after stenting. RESULTS The included patients had an average age of 67.1 ± 10.1 years. IVUS guidance had significantly longer lesion lengths compared with angiographic marking. Based on IVUS-guided stent deployment, nine cases exhibited LGM immediately after stenting. IVUS-marked landing points had a significantly smaller %PV and significantly larger lumen area compared with those for angiography. CONCLUSION IVUS-guided R-PCI was well-tolerated and may be better at preventing LGM compared with angiography-guided R-PCI.
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Affiliation(s)
- Takumi Kimura
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
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4
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Vazquez-Fuster JI, Molina-Lopez VH, Ortiz Cartagena I. Unveiling the Heart of the Matter: Intravascular Ultrasound in Acute Myocardial Infarction. Cureus 2023; 15:e47020. [PMID: 37965399 PMCID: PMC10642281 DOI: 10.7759/cureus.47020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Intravascular ultrasound (IVUS) has become crucial in contemporary percutaneous coronary interventions (PCIs), offering detailed two-dimensional (2D) arterial wall visualization. Current guidelines consider it valuable for guiding coronary stent placement, especially in complex cases like the left main (LM) artery, allowing a comprehensive assessment of vessel characteristics and stent performance. There are some studies that highlight the potential impact of IVUS on acute myocardial infarction (AMI) management, notably improving outcomes. This case involves a 37-year-old man who experienced an AMI, necessitating the use of IVUS to ascertain the underlying cause of his acute coronary syndrome (ACS). This approach was essential for guiding appropriate treatment and ultimately led to successful stent implantation.
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Affiliation(s)
| | | | - Ismael Ortiz Cartagena
- Cardiology, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
- Cardiology, Pavia Hospital, San Juan, PRI
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Şaylık F, Hayıroglu Mİ, Akbulut T, Çınar T. Comparison of Long-Term Outcomes Between Intravascular Ultrasound-, Optical Coherence Tomography- and Angiography-Guided Stent Implantation: A Meta-Analysis. Angiology 2023:33197231198674. [PMID: 37644871 DOI: 10.1177/00033197231198674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided percutaneous coronary interventions (PCI) are alternative techniques to angiography-guided (ANG-g) PCI in patients with coronary artery disease (CAD), especially for optimal stent deployment in coronary arteries. We conducted a network meta-analysis including studies comparing those three techniques. We searched databases for studies that compared IVUS, OCT, and ANG-g PCI in patients with CAD. Overall, 52 studies with 231,137 patients were included in this meta-analysis. ANG-g PCI had higher major adverse cardiovascular events (MACEs), all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) than IVUS-guided PCI. Of note, both OCT-guided and IVUS-guided PCI had similar outcomes. The frequency of MACEs, cardiac death, and MI were higher in ANG-g PCI than in OCT-guided PCI. The highest benefit was established with OCT for MACEs (P-score=.973), MI (P-score=.823), and cardiac death (P-score=.921) and with IVUS for all-cause death (P-score=.792), TLR (P -score=.865), and ST (P-score=.930). This network meta-analysis indicated that using OCT or IVUS for optimal stent implantation provides better outcomes in comparison with ANG-g in patients with CAD undergoing PCI.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Mert İlker Hayıroglu
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Park DY, Vemmou E, An S, Nikolakopoulos I, Regan CJ, Cambi BC, Frampton J, Vij A, Brilakis E, Nanna MG. Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction. IJC HEART & VASCULATURE 2023; 45:101186. [PMID: 36852085 PMCID: PMC9957744 DOI: 10.1016/j.ijcha.2023.101186] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Background Intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is associated with improved outcomes, but these techniques have previously been underutilized in the real world. We aimed to examine the change in utilization of intravascular imaging-guided PCI over the past decade in the United States and assess the association between intravascular imaging and clinical outcomes following PCI for myocardial infarction (MI). Methods We surveyed the National Inpatient Sample from 2008 to 2019 to calculate the number of PCIs for MI guided by IVUS or OCT. Temporal trends were analyzed using Cochran-Armitage trend test or simple linear regression for categorical or continuous outcomes, respectively. Multivariable logistic regression was used to compare outcomes following PCI with and without intravascular imaging. Results A total of 2,881,746 PCIs were performed for MI. The number of IVUS-guided PCIs increased by 309.9 % from 6,180 in 2008 to 25,330 in 2019 (P-trend < 0.001). The percentage of IVUS use in PCIs increased from 3.4 % in 2008 to 8.7 % in 2019 (P-trend < 0.001). The number of OCT-guided PCIs increased 548.4 % from 246 in 2011 to 1,595 in 2019 (P-trend < 0.001). The percentage of OCT guidance in all PCIs increased from 0.0 % in 2008 to 0.6 % in 2019 (P-trend < 0.001). Intravascular imaging-guided PCI was associated with lower odds of in-hospital mortality (adjusted odds ratio 0.66, 95 % confidence interval 0.60-0.72, p < 0.001). Conclusions Although the number of intravascular imaging-guided PCIs have been increasing, adoption of intravascular imaging remains poor despite an association with lower mortality.
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Key Words
- BMS, Bare-metal stent
- CI, Confidence interval
- DES, Drug-eluting stent
- HCUP, Healthcare Cost and Utilization Project
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-10-PCS, International Classification of Diseases, 10th Revision, Procedural Coding System
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- ICD-9-PCS, International Classification of Diseases, 9th Revision, Procedural Coding System
- IVUS
- IVUS, Intravascular ultrasound
- Imaging
- Intravascular
- MI, Myocardial infarction
- Myocardial infarction
- NIS, National Inpatient Sample
- NSTEMI, Non-ST-elevation myocardial infarction
- OCT
- OCT, Optical coherence tomography
- PCI
- PCI, Percutaneous coronary intervention
- STEMI, ST-elevation myocardial infarction
- Trend
- U.S, United States
- aOR, Adjusted odds ratio
- cOR, Crude odds ratio
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Evangelia Vemmou
- Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Seokyung An
- Department of Biomedical Science, Seoul National University, Seoul, Republic of Korea
| | | | | | - Brian C. Cambi
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Emmanouil Brilakis
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Corresponding author at: Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
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Garot P, Leon MB, Saito S, Baumbach A, Kereiakes DJ, Windecker S, Pietras C, Dressler O, Issever MO, Curtis M, Bertolet BD, Zidar JP, Smits PC, Jiménez Diaz VA, McLaurin B, Cequier AR, Hofma SH, Dib N, Namiki A, Takahashi A, Kakuta T, Hirohata A, Lansky AJ. Geographic Variations on the Safety and Efficacy of the Supreme Biodegradable Polymer DES: Results From PIONEER III. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100515. [PMID: 39132534 PMCID: PMC11308104 DOI: 10.1016/j.jscai.2022.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 08/13/2024]
Abstract
Background The PIONEER III trial showed the 12-month safety and efficacy of the Supreme drug-eluting stent (DES) vs the durable polymer everolimus-eluting stent. We sought to assess whether the characteristics and clinical outcomes of the Supreme DES in PIONEER III were consistent among patients by enrollment location. Methods This subgroup analysis of the PIONEER III trial compared the characteristics and outcomes of patients recruited from North America, Europe, and Japan and the relative differences in patient outcomes according to the site recruitment volume. Results From October 2017 to July 2019, 1629 patients were recruited in North America (816, 50.1%), Europe (650, 39.9%), and Japan (163, 10%). Procedural success was achieved in 1556 of 1611 procedures (96.6%), with no difference by the geographic location. Target lesion failure at 12 months for combined groups was observed in 84 of 1629 patients (5.2%), with no significant geographic differences (4.7%, 6.5%, and 2.5%, respectively; P =.08), with similar results in the Supreme DES group alone (4.4%, 6.8%, and 3.7%, respectively, P =.20). Cardiac death at 12 months occurred in 0.4%, 0.2%, and 0.0% (P =.79), target vessel-related myocardial infarction occurred in 2.2%, 4.7%, and 3.7%, (P =.10), and clinically driven target lesion revascularization was required in 2.1%, 3.1%, and 0%, respectively (P =.15). Compared with those from high-recruiting sites, results from low-recruiting sites were similar for target lesion failure, major adverse cardiac events, stent thrombosis, and mortality, with a nonsignificant trend for higher rates of myocardial infarction. Conclusions Despite regional differences in patient characteristics, the clinical outcomes between Supreme DES and durable polymer everolimus-eluting stent in the PIONEER III trial were not different, supporting the generalizability and robustness of the findings from this multicenter controlled trial.
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Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Martin B. Leon
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
- Cardiovascular Research Foundation, New York, New York
| | | | - Andreas Baumbach
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, United Kingdom
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Cody Pietras
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | | | - James P. Zidar
- North Carolina Heart and Vascular, University of North Carolina, Raleigh, North Carolina
| | | | | | | | - Angel R. Cequier
- Bellvitge University Hospital, University of Barcelona, IDIBELL, Barcelona, Spain
| | - Sjoerd H. Hofma
- Medisch Centrum Leeuwarden, Hartcentrum Friesland, Leeuwarden, the Netherlands
| | - Nabil Dib
- Mercy Gilbert Medical Center, Gilbert, Arizona
| | - Atsuo Namiki
- Department of Cardiology, JOHAS Kanto-Rosai Hospital, Kanagwa, Japan
| | | | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Atsushi Hirohata
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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8
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Dąbrowski EJ, Kożuch M, Dobrzycki S. Left Main Coronary Artery Disease-Current Management and Future Perspectives. J Clin Med 2022; 11:jcm11195745. [PMID: 36233613 PMCID: PMC9573137 DOI: 10.3390/jcm11195745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
Due to its anatomical features, patients with an obstruction of the left main coronary artery (LMCA) have an increased risk of death. For years, coronary artery bypass grafting (CABG) has been considered as a gold standard for revascularization. However, notable advancements in the field of percutaneous coronary intervention (PCI) led to its acknowledgement as an important treatment alternative, especially in patients with low and intermediate anatomical complexity. Although recent years brought several random clinical trials that investigated the safety and efficacy of the percutaneous approach in LMCA, there are still uncertainties regarding optimal revascularization strategies. In this paper, we provide a comprehensive review of state-of-the-art diagnostic and treatment methods of LMCA disease, focusing on percutaneous methods.
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9
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Hannan EL, Zhong Y, Reddy P, Jacobs AK, Ling FSK, King Iii SB, Berger PB, Venditti FJ, Walford G, Tamis-Holland J. Percutaneous Coronary Intervention With and Without Intravascular Ultrasound for Patients With Complex Lesions: Utilization, Mortality, and Target Vessel Revascularization. Circ Cardiovasc Interv 2022; 15:e011687. [PMID: 35543139 DOI: 10.1161/circinterventions.121.011687] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) has several benefits during percutaneous coronary interventions (PCIs), including more accurate vessel sizing, improved stent expansion, and better strut apposition. Prior clinical trials have demonstrated a reduction in cardiac events when IVUS is used. However, there is limited information about the utilization of IVUS and the outcomes of IVUS-guided versus angiography-guided PCI in patients with complex lesions in a contemporary population-based setting. METHODS New York's PCI registry was used to identify 44 305 patients with complex lesions (lesions that complicate stenting or that require multiple stents) undergoing PCI with and without IVUS guidance and discharged between December 1, 2013 and November 30, 2018. Trends and inter-hospital variation in IVUS use were examined. Risk-adjusted mortality and target vessel revascularization were compared. RESULTS A total of 6174 (13.9%) PCI patients underwent IVUS-guided PCI. The median follow-up period was 2.5 years. The percent of patients with complex lesions who underwent IVUS-guided PCI rose from 13.4% in 2014 to 16.5% in 2018 (P<0.0001 for trend), with the main increases occurring in the last 2 years of the period. Only 31 of 66 hospitals in the study used IVUS for >5% of their study patients. IVUS-guided PCI patients experienced significantly lower mortality (adjusted hazard ratio=0.89 [0.79-0.98] after adjustment using a Cox proportional hazards model, and HR=0.88 [0.78-0.99] for propensity-matched patients). We also found that IVUS-guided PCI patients had a lower rate of target vessel revascularization (adjusted hazard ratio=0.88 [0.80-0.97]) after adjusting using Cox proportional hazards with competing risk of mortality and after propensity matching (0.88 [0.79-0.99]). CONCLUSIONS Utilization of IVUS for complex lesions has increased but contemporary rates remain low, and there are large inter-hospital variations. The use of IVUS for complex lesions was associated with lower risk of medium-term mortality and target vessel revascularization.
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Affiliation(s)
- Edward L Hannan
- Department of Health Policy' Management and Behavior' University at Albany, State University of New York (E.L.H., Y.Z.)
| | - Ye Zhong
- Department of Health Policy' Management and Behavior' University at Albany, State University of New York (E.L.H., Y.Z.)
| | - Pavan Reddy
- Department of Cardiology' Mount Sinai St. Luke's Hospital, New York (P.R., J.T.-H.)
| | - Alice K Jacobs
- Department of Cardiology' Boston Medical Center, MA (A.K.J.)
| | - Frederick S K Ling
- Department of Cardiology' University of Rochester Medical Center, NY (F.S.K.L.)
| | | | - Peter B Berger
- Department of Health Policy' Management and Behavior' University at Albany, State University of New York (E.L.H., Y.Z.)
| | | | - Gary Walford
- Department of Cardiology' Johns Hopkins Medical Center, Baltimore, MD (G.W.)
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10
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Use of intravascular ultrasound and long-term cardiac death or myocardial infarction in patients receiving current generation drug-eluting stents. Sci Rep 2022; 12:8237. [PMID: 35581318 PMCID: PMC9114360 DOI: 10.1038/s41598-022-12339-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/09/2022] [Indexed: 11/12/2022] Open
Abstract
Long-term follow-up data on differential effects of intravascular ultrasound (IVUS) according to lesion complexity are limited in patients undergoing percutaneous coronary intervention (PCI). The current study compared long-term clinical outcomes between IVUS-guided and angiography-guided PCI in patients with second-generation drug-eluting stents (DES). Between February 2008 and December 2015, 5488 patients undergoing PCI with second-generation DES were recruited from an institutional registry of Samsung Medical Center. The primary outcome was a composite of cardiac death or myocardial infarction (MI) during 46 months of median follow-up (interquartile range: 32–102 months). IVUS-guided PCI was performed in 979 patients (17.8%). IVUS-guided PCI was associated with a significantly lower risk of cardiac death or MI compared with angiography-guided PCI (5.7% vs. 12.9%, hazard ratio 0.408, 95% confidence interval 0.284–0.587, p < 0.001). Results were consistent after propensity score matching analysis with 801 matched pairs. In subgroup analysis, there was no significant interaction between lesion complexity (defined by complex procedures, Pinteraction = 0.819, ACC/AHA lesion classification, Pinteraction = 0.401 or SYNTAX score, Pinteraction = 0.149) and use of IVUS for risk of cardiac death or MI. IVUS-guided second-generation DES implantation was associated with a significantly lower long-term risk of cardiac death or MI compared with angiography guidance, regardless of lesion complexity.
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11
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The Clinical Effects of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion: A Meta-Analysis. Cardiol Res Pract 2022; 2022:4170060. [PMID: 35342644 PMCID: PMC8947918 DOI: 10.1155/2022/4170060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background The clinical effects of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) lesions remain unclear. Methods We identified all full-text published studies that compared the effects of IVUS-guided CTO-PCI with angiography-guided CTO-PCI by searching electric databases including PubMed, Embase, Cochrane Library, and ISI Web of Science from the establishment to Nov 2021. There was no language limitation. The endpoints included the incidence of major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Results Five studies involving a total of 2320 patients were included in this meta-analysis. Compared to the angiography-guided group, IVUS-guided PCI showed no significant reduction in the incidence of MACE (I2 = 27.4%, P = 0.239; RR 0.929, 95% CI 0.765 to 1.128, P = 0.457), cardiac death (I2 = 0.0%, P = 0.459; RR 0.574, 95% CI 0.299 to 1.103, P = 0.096), all-cause death (I2 = 0.0%, P = 0.964; RR 0.677, 95% CI 0.395 to 1.163, P = 0.158), MI (I2 = 46.7%, P = 0.131; RR0.836, 95% CI 0.508 to 1.377, P = 0.482), and TVR (I2 = 21.2%, P = 0.279; RR 0.929, 95% CI 0.679 to 1.272, P = 0.648). Conclusions IVUS-guided PCI demonstrated no significant benefit on MACE, cardiac death, all-cause death, MI, and TVR in patients with CTO lesions. However, given the study's limitations, additional high-quality RCTs are needed.
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Short- and Long-Term Prognosis of Intravascular Ultrasound-Versus Angiography-Guided Percutaneous Coronary Intervention: A Meta-Analysis Involving 24,783 Patients. J Interv Cardiol 2021; 2021:6082581. [PMID: 34737679 PMCID: PMC8536416 DOI: 10.1155/2021/6082581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) has potential benefits. This meta-analysis aimed to explore whether IVUS-guided PCI had better short- and long-term prognoses than angiography-guided PCI. Methods We retrieved studies from PubMed, Embase, and Cochrane Library. Clinical trials including retrospective and randomized controlled trials (RCTs) that compared IVUS-guided PCI with angiography-guided PCI were included. The patients were followed up after operation at 30 days, 1 year, 2 years, and 3 years. The clinical outcomes were target lesion revascularization (TLR), target vessel revascularization (TVR), and MACEs, including stent thrombosis (ST), myocardial infarction (MI), cardiac death, and all-cause death. The study population included patients with MI, coronary bifurcation lesions, short or long lesions, and unprotected left main coronary artery stenosis (ULMCA). The quality of retrospective trials was evaluated using the Newcastle-Ottawa Scale, and the quality of randomized controlled trials was evaluated using the Jadad score. A total of 20 clinical trials met the criteria. Three trials were randomized controlled trials, while 17 were retrospective trials. Results A total of 24,783 patients were included. In observational trials, the OR of MACEs was 0.49 (95% CI: 0.38-0.62) in 30 days, 0.65 (95% CI: 0.58-0.73) in one year, 0.51 (95% CI: 0.36-0.71) in two years, and 0.45 (95% CI: 0.31-0.65) in three years. In patients with long coronary lesions, the OR of MACEs in 1 year was 0.64 (95% CI: 0.28-1.50). In patients with left main artery disease, the OR of MACEs in 3 years was 0.42 (95% CI: 0.26-0.67). Compared with angiography-guided PCI, IVUS-guided PCI was associated with a lower incidence of MACEs during the same following period. Conclusion Compared with angiography-guided PCI, IVUS-guided PCI has better performance in reducing the occurrence of MACEs.
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Darmoch F, Ullah W, Al-Khadra Y, Sattar Y, Pacha HM, Zghouzi M, Soud M, Bagur R, Naidu SS, Goldsweig AM, Mamas M, Brilakis ES, Alraies MC. Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis. Expert Rev Cardiovasc Ther 2021; 19:865-870. [PMID: 34330193 DOI: 10.1080/14779072.2021.1963233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suboptimal stent delivery and deployment in calcified coronary lesions are associated with a poor clinical outcome. METHODS Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not. RESULTS A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P < 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P < 0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P < 0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P < 0.001), and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P < 0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging. CONCLUSION Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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Affiliation(s)
- Fahed Darmoch
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Yasser Al-Khadra
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Homam Moussa Pacha
- Department ofCardiology, University of Texas Health Science Center, Houston, Texas, USA
| | - Mohamed Zghouzi
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Andrew M Goldsweig
- Department of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mamas Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Chadi Alraies
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Murata N, Fukamachi D, Matsumoto N, Tachibana E, Oiwa K, Matsumoto M, Kojima T, Ichikawa M, Nomoto K, Arima K, Okumura Y. Clinical outcomes for intracoronary imaging strategies at different medical facilities in Japanese patients with coronary artery disease: the SAKURA imaging PCI Registry. Heart Vessels 2021; 37:12-21. [PMID: 34363517 DOI: 10.1007/s00380-021-01896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
The relationships between intracoronary imaging modalities and outcomes among Japanese patients with coronary artery disease (CAD) based on the type of medical facility providing outpatient care remain unclear. In this multicenter prospective study (SAKURA PCI Registry), we aimed to investigate the clinical outcomes of patients with CAD who underwent percutaneous coronary intervention (PCI) between April 2015 and December 2018. In this registry, we investigated differences in patient characteristics, intracoronary imaging modalities, and clinical outcomes between two types of medical facilities. Of the 414 patients enrolled in this registry, 196 were treated at two university hospitals, and 218 were treated at five community hospitals (median follow-up 11.0 months). The primary endpoint was clinically relevant events (CREs), including a composite of all-cause death, non-fatal myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, stroke, and major bleeding. Patients treated at university hospitals had higher rates of diabetes (50% vs. 38%, p = 0.015) and malignant tumors (12% vs. 6%, p = 0.015) and more frequent use of multiple intracoronary imaging modalities than patients treated at community hospitals (21% vs. 0.5%, p < 0.001). The Kaplan-Meier incidence of CREs at 1 year was comparable between university hospitals and community hospitals (8.8% vs. 7.3%, p = 0.527, log-rank test). Despite the relatively higher risk among patients in university hospitals with frequent use of multi-intracoronary imaging modalities, adverse clinical events appeared to be comparable between patients with CAD treated at university and community hospitals in Japan.
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Affiliation(s)
- Nobuhiro Murata
- Department of Medicine, Division of Cardiology, Nihon University Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Department of Medicine, Division of Cardiology, Nihon University Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | | | - Koji Oiwa
- Yokohama Chuo Hospital, Kanagawa, Japan
| | | | | | | | | | - Ken Arima
- Kasukabe Municipal Hospital, Saitama, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
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15
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Ya'qoub L, Gad M, Saad AM, Elgendy IY, Mahmoud AN. National trends of utilization and readmission rates with intravascular ultrasound use for ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2021; 98:1-9. [PMID: 33576172 DOI: 10.1002/ccd.29524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Randomized trials have confirmed that intravascular ultrasound (IVUS) guidance for percutaneous coronary interventions (PCI) improves long-term clinical outcomes. However, data on real-world utilization of IVUS in ST-elevation myocardial infarction (STEMI) and the impact on short to mid-term outcomes are scarce. We sought to evaluate the utilization and the readmission rates for IVUS-guided PCI in the setting of STEMI. METHODS Hospitalizations with a primary diagnosis of STEMI undergoing PCI were included from the Nationwide Readmissions Database (NRD) during 2012-2017. RESULTS Among 809,601 hospitalizations with STEMI undergoing PCI, 33,644 (4.2%) underwent IVUS-guided PCI. IVUS use increased from 4.2% in 2012 to 5.6% in 2017 (p < .0001). After matching, in-hospital mortality was significantly lower with IVUS use (3.9% vs. 4.6%, p < .0001). The overall readmission rates were similar in both groups. We found that readmission rates due to acute MI at 6 months (5.7% vs. 6%, p = .045) and 11 months (5.1% vs. 6.5%, p = .005) as well as the PCI and mortality rates during readmission at 11 months (2.1% vs. 3%, p = .008, and 0.7% vs. 1.4%, p = .002, respectively) were significantly lower in the IVUS group. CONCLUSIONS The utilization of IVUS in STEMI appears to be slowly increasing. Although overall readmission rates were similar, IVUS was associated with lower in-hospital mortality, lower rates of readmission due to acute MI at 6 and 11 months, as well as lower PCI and mortality at 11 months. Randomized trials evaluating long-term benefits of IVUS in STEMI are needed.
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Affiliation(s)
- Lina Ya'qoub
- Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas M Saad
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmed N Mahmoud
- Division of Cardiology, Case Western Reserve University, and Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
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Li L, Hu X, Tao X, Shi X, Zhou W, Hu H, Hu X. Radiomic features of plaques derived from coronary CT angiography to identify hemodynamically significant coronary stenosis, using invasive FFR as the reference standard. Eur J Radiol 2021; 140:109769. [PMID: 33992980 DOI: 10.1016/j.ejrad.2021.109769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to investigate the diagnostic performance of radiomics features derived from coronary computed tomography angiography (CCTA) in the identification of ischemic coronary stenosis plaque using invasive fractional flow reserve (FFR) as the reference standard. MATERIALS AND METHODS 174 plaques of 149 patients (age: 62.21 ± 8.47 years, 96 males) with at least one lesion stenosis degree between 30 % and 90 % were retrospectively included. Stenosis degree and plaque characteristics were recorded, and a conventional multivariate logistic model was established. Over 1000 radiomics features of the plaque were derived from CCTA images. The plaques were randomly divided into training set (n = 139) and validation set (n = 35). A random forest model was built. The area under the curve (AUC) of the models was compared. RESULTS Fifty-eight radiomics features were correlated with functionally significant stenosis (p < 0.05), wherein 56 features had an AUC of >0.6. NCP volume, NRS, remodeling index, and spotty calcification were included in the conventional model. Ultimately, 14 features were integrated to build the radiomics model. The AUC showed an improvement: 0.71 vs 0.82 for the training set and 0.70 vs 0.77 for the validation set (conventional model and radiomics model, respectively); however, it was not statistically significant (p = 0.58). CONCLUSION The radiomics analysis of plaques showed improvement compared with conventional plaques assessment in identifying hemodynamically significant coronary stenosis. The statistical advancement of machine learning for plaques to predict hemodynamic stenosis with a noninvasive approach still needs further studies on a large-scale dataset.
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Affiliation(s)
- Lin Li
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310010, China.
| | - Xi Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310010, China.
| | - Xinwei Tao
- Siemens Healthineers China, No.278, Road Zhouzhu, Shanghai, 201314, China.
| | - Xiaozhe Shi
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310010, China.
| | - Wenli Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310010, China.
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310010, China.
| | - Xiuhua Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310010, China.
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Otake H, Kubo T, Shinke T, Hibi K, Tanaka S, Ishida M, Kataoka T, Takaya T, Iwasaki M, Sonoda S, Ioji T, Akasaka T. OPtical frequency domain imaging vs. INtravascular ultrasound in percutaneous coronary InterventiON in patients with Acute Coronary Syndrome: Study protocol for a randomized controlled trial. J Cardiol 2020; 76:317-321. [PMID: 32340781 DOI: 10.1016/j.jjcc.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A recent clinical trial demonstrated that optical frequency domain imaging (OFDI) guidance in percutaneous coronary intervention (PCI) is noninferior to intravascular ultrasound (IVUS) guidance in patients with coronary artery disease with regard to target vessel failure (composed of cardiac death, myocardial infarction attributed to the target vessel, and clinically-driven target vessel revascularization) at 12 months. The impact of OFDI guidance in PCI for patients with acute coronary syndrome (ACS) remains uncertain. METHODS OPINION ACS is a multicenter, prospective, randomized, controlled, open-label, parallel group, non-inferiority trial in Japan. Eligible patients will be randomly assigned to receive either OFDI- or IVUS-guided PCI. PCI is performed using the sirolimus-eluting stent in accordance with certain OFDI and IVUS criteria for optimal stent deployment. All patients will undergo follow-up angiography and OFDI imaging at 8 months. The primary endpoint is the minimum lumen area, as measured by OFDI at 8 months. CONCLUSION The OPINION ACS trial outcomes will provide insights regarding the impact of OFDI-guided PCI on in-stent restenosis at 8 months in patients with ACS.
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Affiliation(s)
- Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigemitsu Tanaka
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masaru Ishida
- Division of Cardiology, Iwate Medical University, Yahaba-cho, Japan
| | - Toru Kataoka
- Division of Cardiology, Bell Land General Hospital, Sakai, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Hyogo Prefectural Himeji Cardiovascular Center, Himeji, Hyogo, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Shinjo Sonoda
- The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tetsuya Ioji
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Kobe, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Mentias A, Sarrazin MV, Saad M, Panaich S, Kapadia S, Horwitz PA, Girotra S. Long-Term Outcomes of Coronary Stenting With and Without Use of Intravascular Ultrasound. JACC Cardiovasc Interv 2020; 13:1880-1890. [PMID: 32819477 PMCID: PMC7444477 DOI: 10.1016/j.jcin.2020.04.052] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study sought to explore if intravascular ultrasound (IVUS) use in real-world patients is associated with improved long-term outcomes of percutaneous coronary intervention (PCI). BACKGROUND The benefit of IVUS use with PCI in real world is uncertain. METHODS We identified Medicare patients who underwent PCI from 2009 to 2017 and evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. We used propensity score matching and inverse probability weighting to adjust for baseline characteristics. To account for hospital effects, patients undergoing IVUS-guided PCI were matched to non-IVUS patients in the same hospital and year. Sensitivity analyses comparing outcomes with and without IVUS in stable coronary artery disease and acute coronary syndrome, PCI with bare-metal stents and drug-eluting stents, complex and noncomplex PCI, and facilities with 1% to 5%, 5% to 10%, and >10% IVUS use were performed. RESULTS Overall, IVUS was used in 5.6% of all PCI patients (105,787 out of 1,877,177 patients). Patients with IVUS-guided PCI had a higher prevalence of most comorbidities. In the propensity matched analysis, IVUS-guided PCI was associated with lower 1-year mortality (11.5% vs. 12.3%), MI (4.9% vs. 5.2%), and repeat revascularization (6.1% vs. 6.7%) (p < 0.001 for all). In inverse probability weighting analysis with a median follow-up of 3.7 years (interquartile range: 1.7 to 6.4 years), IVUS-guided PCI was associated with a lower risk of mortality (adjusted hazard ratio [aHR]: 0.903; 95% confidence interval [CI]: 0.885 to 0.922), MI (aHR: 0.899; 95% CI: 0.893 to 0.904), and repeat revascularization (aHR: 0.893; 95% CI: 0.887 to 0.898) (p < 0.001 for all). These findings were consistent in all subgroups in sensitivity analyses. CONCLUSIONS In this contemporary U.S. Medicare cohort, the use of IVUS guidance in PCI remains low. Use of IVUS is associated with lower long-term mortality, MI, and repeat revascularization.
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Affiliation(s)
- Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Mary Vaughan Sarrazin
- Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
| | - Marwan Saad
- Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Saket Girotra
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Darmoch F, Alraies MC, Al-Khadra Y, Moussa Pacha H, Pinto DS, Osborn EA. Intravascular Ultrasound Imaging-Guided Versus Coronary Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e013678. [PMID: 32075491 PMCID: PMC7335557 DOI: 10.1161/jaha.119.013678] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of PCI. However, the long‐term beneficial effect of IVUS over PCI guided by coronary angiography (CA) alone remains under question. We sought to investigate the outcomes of IVUS‐guided compared with CA‐guided PCI. Methods and Results We performed a comprehensive search of PubMed, Medline, and Cochrane Central Register, looking for randomized controlled trials and observational studies that compared PCI outcomes of IVUS with CA. Data were aggregated for the primary outcome measure using the random‐effects model as pooled risk ratio (RR). The primary outcomes were the rate of cardiovascular death, need for target lesion revascularization, occurrence of myocardial infarction, and rate of stent thrombosis. A total of 19 studies met the inclusion criteria, comprising 27 610 patients divided into IVUS (n=11 513) and CA (n=16 097). Compared with standard CA‐guided PCI, we found that the risks of cardiovascular death (RR, 0.63; 95% CI, 0.54–0.73), myocardial infarction (RR, 0.71; 95% CI, 0.58–0.86), target lesion revascularization (RR, 0.81; 95% CI, 0.70–0.94), and stent thrombosis (RR, 0.57; 95% CI, 0.41–0.79) were all significantly lower using IVUS guidance. Conclusions Compared with standard CA‐guided PCI, the use of IVUS imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis.
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Affiliation(s)
- Fahed Darmoch
- Beth Israel Deaconess Medical Center/Harvard School of Medicine Boston MA
| | | | | | | | - Duane S Pinto
- Beth Israel Deaconess Medical Center/Harvard School of Medicine Boston MA
| | - Eric A Osborn
- Beth Israel Deaconess Medical Center/Harvard School of Medicine Boston MA
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Lemor A, Patel N, Jain T, Baber U, Hernandez G, Villablanca P, Basir MB, Alaswad K, Mehran R, Dangas G, Sharma SK, Kini A. Trends and Outcomes of Intravascular Imaging-guided Percutaneous Coronary Intervention in the United States. Crit Pathw Cardiol 2020; 19:69-74. [PMID: 31895248 DOI: 10.1097/hpc.0000000000000194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Intravascular imaging-guided percutaneous coronary intervention (PCI) has shown to improve outcomes in randomized controlled trials. However, there are little real-world data about intravascular imaging utilization during PCI and its outcomes in the United States. METHODS We conducted an observational analysis on the use of intravascular imaging (Intravascular Ultrasound or Optical Coherence Tomography)-guided PCI in 2,425,036 patients undergoing PCI between January 2010 and December 2014 from the Nationwide Inpatient Sample database. Utilizing propensity score matching, 83,988 matched pairs were identified. The primary outcome was in-hospital mortality. The secondary outcomes included cardiogenic shock and acute kidney injury. RESULTS Among the 2,425,036 patients, 161,808 (6.7%) underwent imaging-guided PCI. Use of imaging-guidance increased from 6% in 2010 to 6.6% in 2014 (Ptrend < 0.001). The in-hospital mortality was significantly different between imaging-guided PCI and angiography-guided PCI [1.0% vs. 1.5%; adjusted OR: 0.67; 95% confidence interval (CI): 0.54-0.83, P < 0.001]. The rates of cardiogenic shock (2.5% vs. 3.1%; adjusted OR: 0.78; 95% CI: 0.66-0.93; P = 0.005) were significantly lower in imaging-guided PCI group and acute kidney injury rates (7.0% vs. 7.1%; adjusted OR: 0.99; 95% CI: 0.89-1.12; P = 0.919) were not significantly different. CONCLUSIONS Imaging-guided PCI is associated with lower in-hospital mortality. Yet, a small proportion of patients undergoing PCI have imaging-guidance.
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Affiliation(s)
- Alejandro Lemor
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI.,Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación de Epidemiología Clínica y Medicina Basada en la Evidencia Lima, Peru
| | - Nish Patel
- Department of Cardiology, The Mount Sinai Hospital, New York, NY
| | - Tarun Jain
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Usman Baber
- Department of Cardiology, The Mount Sinai Hospital, New York, NY
| | - Gabriel Hernandez
- Department of Cardiology, University of Miami/Jackson Memorial Hospital, Miami, FL
| | | | - Mir B Basir
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Khaldoon Alaswad
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Roxana Mehran
- Department of Cardiology, The Mount Sinai Hospital, New York, NY
| | - George Dangas
- Department of Cardiology, The Mount Sinai Hospital, New York, NY
| | - Samin K Sharma
- Department of Cardiology, The Mount Sinai Hospital, New York, NY
| | - Annapoorna Kini
- Department of Cardiology, The Mount Sinai Hospital, New York, NY
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Intravascular ultrasound-guided stent implantation reduces cardiovascular mortality - Updated meta-analysis of randomized controlled trials. Int J Cardiol 2020; 299:100-105. [PMID: 31345647 DOI: 10.1016/j.ijcard.2019.07.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/19/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022]
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Intravascular ultrasound versus angiography-guided drug-eluting stent implantation in patients with complex coronary lesions: An updated meta-analysis of nine randomized clinical trials. Anatol J Cardiol 2019; 22:160-167. [PMID: 31584443 PMCID: PMC6955085 DOI: 10.14744/anatoljcardiol.2019.86598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Intravascular ultrasound (IVUS) is not routinely performed in the real-world practice, and the benefits of IVUS-guided drug-eluting stent (DES) implantation in patients with complex coronary lesions remains unclear. This updated meta-analysis attempts to evaluate the clinical outcomes of the IVUS guidance in these patients. Methods: We searched potential eligible citations from the PubMed, EMBASE, Medline, and other internet sources. The primary endpoint were major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). The risk of definite/probable stent thrombosis (ST) was chosen as the safety endpoint. Results: Nine randomized trials including a total of 3,612 patients with complex coronary lesions were finally analyzed. Compared to angiography guidance, IVUS-guided DES implantation was associated with significantly lower incidence of MACE [odds ratios (OR) 0.57, 95% confidence intervals (CI): 0.45–0.72, p<0.001; I2=0.0%, p=0.674], cardiac death (OR 0.42, 95%CI:0.21–0.82, p=0.010; I2=0.0%, p=0.961), MI (OR 0.65, 95%CI:0.44–0.95, p=0.027; I2=41.8%, p=0.089), TVR (OR 0.55, 95%CI:0.38–0.79, p=0.001; I2=0.0%, p=0.916), target lesion revascularization (TLR) (OR 0.58, 95%CI:0.41–0.82, p=0.002; I2=0.0%, p=0.888), and ST (OR 0.48, 95%CI:0.24–0.93, p=0.029; I2=0.0%, p=0.733). Conclusion: The updated meta-analysis demonstrates that DES implantation under IVUS guidance leads to a significant reduction in MACE, cardiac death, MI, TVR, TLR, and ST among patients with complex coronary lesions.
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Mintz GS. Intravascular ultrasound guidance improves patient survival (mortality) after drug-eluting stent implantation: review and updated bibliography. Cardiovasc Interv Ther 2019; 35:37-43. [PMID: 31482290 DOI: 10.1007/s12928-019-00616-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
Individual studies IVUS vs angiography-guided DES implantation studies, whether randomized clinical trials or registries are underpowered, to show a reduction in mortality, especially at 1 year of follow-up. However, either meta-analyses or the few studies with long-term (> 5 year) follow-up showed that IVUS guidance reduced mortality and improved patient survival, even with second-generation DES.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, 9th floor, New York, NY, 10019, USA.
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24
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Desai R, Patel U, Fong HK, Sadolikar A, Zalavadia D, Gupta S, Doshi R, Sachdeva R, Kumar G. Modern-Day Nationwide Utilization of Intravascular Ultrasound and Its Impact on the Outcomes of Percutaneous Coronary Intervention With Coronary Atherectomy in the United States. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2295-2304. [PMID: 30609082 DOI: 10.1002/jum.14922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/27/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Intravascular ultrasonography (IVUS) and coronary atherectomy (CA) are useful modalities in managing calcified coronary lesions. Considering an inadequacy of data, we aimed to compare the outcomes with versus without IVUS assistance in percutaneous coronary interventions (PCIs) with CA. METHODS From the National (Nationwide) Inpatient Sample data set for the years 2012 to 2014, we identified adult patients undergoing PCI and CA with or without IVUS assistance using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We assessed the impact of IVUS on procedural outcomes, length of stay, total hospital charges, and predictors of IVUS utilization by multivariable analyses. Discharge weights were used to calculate national estimates. RESULTS A total of 46,095 PCIs with CA procedures were performed from 2012 to 2014, of these, 4800 (10.4%) procedures were IVUS-assisted. IVUS-assisted procedures showed lower odds of in-hospital mortality (odds ratio, 0.57; P = .024) but higher odds of any cardiac complication (odds ratio, 1.25; P = .025). Total hospital charges were higher in IVUS-assisted procedures without any substantial difference in the length of stay between the groups. Cardiac complication rates declined (from 16.2% to 14.8%) from 2012 to 2014, whereas inpatient mortality increased (1.1%-4.4%) in IVUS-assisted procedures during the same period. The odds of IVUS utilization were higher in Asian/Pacific Islander and urban teaching and western region hospitals. Comorbidities, including hypertension, obesity, and chronic pulmonary disease, raised odds of IVUS utilization. CONCLUSIONS IVUS-assisted procedures showed lower in-hospital mortality and higher iatrogenic and overall cardiac complications. The mortality rate in patients undergoing IVUS-assisted PCI with CA was on the rise, with declining cardiac complication rates from 2012 to 2014.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
| | - Hee Kong Fong
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Ashish Sadolikar
- Department of Internal Medicine, Florida International University, Miami, Florida, USA
| | - Dipen Zalavadia
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Sonu Gupta
- Division of Cardiology, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia, USA
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Ieroncig F, Breau JB, Bélair G, David LP, Noiseux N, Hatem R, Avram R. Novel Approaches to Define Outcomes in Coronary Revascularization. Can J Cardiol 2019; 35:967-982. [DOI: 10.1016/j.cjca.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
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Kuno T, Numasawa Y, Sawano M, Abe T, Ueda I, Kodaira M, Suzuki M, Noma S, Nakamura I, Negishi K, Ishikawa S, Fukuda K, Kohsaka S. Real-world use of intravascular ultrasound in Japan: a report from contemporary multicenter PCI registry. Heart Vessels 2019; 34:1728-1739. [DOI: 10.1007/s00380-019-01427-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/15/2019] [Indexed: 01/30/2023]
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27
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Rozemeijer R, Wing Wong C, Leenders G, Timmers L, Koudstaal S, Rittersma SZ, Kraaijeveld A, Bots M, Doevendans P, Stella P, Voskuil M. Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients. Neth Heart J 2019; 27:321-329. [PMID: 30895527 PMCID: PMC6533324 DOI: 10.1007/s12471-019-1253-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p < 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p < 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, plog-rank < 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity. Electronic supplementary material The online version of this article (10.1007/s12471-019-1253-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Rozemeijer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C Wing Wong
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Epidemiology, Julius Centrum, Utrecht, The Netherlands
| | - S Z Rittersma
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Bots
- Department of Epidemiology, Julius Centrum, Utrecht, The Netherlands
| | - P Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - P Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Safety and Long-Term Efficacy of Drug-Coated Balloon Angioplasty following Rotational Atherectomy for Severely Calcified Coronary Lesions Compared with New Generation Drug-Eluting Stents. J Interv Cardiol 2019; 2019:9094178. [PMID: 31772551 PMCID: PMC6739772 DOI: 10.1155/2019/9094178] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 02/11/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives This study sought to assess the safety and long-term efficacy of drug-coated balloons (DCB) following aggressive intracoronary image-guided rotational atherectomy (iRA) for severe coronary artery calcification (CAC), and to compare this strategy with new generation drug-eluting stents (nDES) following iRA. Background Ischemic events following the treatment of CAC is still relatively high. Thus, more innovative strategies are required. Methods We evaluated 123 consecutive patients (166 lesions) with de novo CAC undergoing an iRA (burr size; 0.7 of the mean reference diameter by intracoronary imaging) followed by DCB (DCB-iRA; 54 patients, 68 lesions) or nDES (nDES-iRA; 69 patients, 98 lesions). Follow-up angiography was obtained at > 6 months. Results The target vessels (right coronary and circumflex), bifurcation (67.6% versus 47.9%), reference diameter (2.28mm versus 2.49mm), and lesion length (11.89mm versus 18.78mm) were significantly different between the two groups. The median follow-up was 732 days. TLR and TVR in DCB-iRA and nDES-iRA at 3 years were similar: 15.6% versus 16.3% (P=0.99) and 15.6% versus 23.3% (P=0.38). In 41 well-matched lesion pairs after propensity score analysis, the cumulative incidence of TLR and TVR in DCB-iRA and nDES-iRA at 3 years was 12.9% versus 16.3% (P=0.70) and 12.9% versus 26.1% (P=0.17), respectively. On QCA analysis, although the acute gain was smaller in DCB-iRA (0.85 mm versus 1.53 mm, P<0.001), the minimum lumen diameter at follow-up was similar (1.69 mm versus 1.87 mm, P=0.29). The late lumen loss was lower (0.09 mm versus 0.52 mm, P=0.009) in DCB-iRA. Conclusions DCB-iRA is feasible for CAC.
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Lynn BS, Hermiller JB. Treatment of Bifurcation Lesions: Has DK Crush"ed" the Competition? Curr Cardiol Rep 2018; 20:101. [PMID: 30173390 DOI: 10.1007/s11886-018-1024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This paper reviews the double-kiss crush (DK crush) technique in coronary artery bifurcation lesions. The technical aspects of the procedure and the clinical data supporting its use are summarized. RECENT FINDINGS Randomized studies support the adoption of DK technique in complex bifurcation lesions for both left main and non-left-main lesions. For true bifurcation lesions, DK crush may become the default technique for lesions in which the side-branch disease is complex and long. Optimal technique is essential for obtaining the clinical outcomes noted in the DKCRUSH randomized studies.
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Affiliation(s)
- Bryce S Lynn
- St Vincent Medical Group, St Vincent Heart Center, 10590 N Meridian, Indianapolis, IN, 46290, USA
| | - James B Hermiller
- St Vincent Medical Group, St Vincent Heart Center, 10590 N Meridian, Indianapolis, IN, 46290, USA.
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Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention With Stent Implantation. JACC Cardiovasc Interv 2017; 10:2488-2498. [DOI: 10.1016/j.jcin.2017.08.051] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022]
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Ochijewicz D, Tomaniak M, Koltowski L, Rdzanek A, Pietrasik A, Kochman J. Intravascular imaging of coronary artery disease. J Cardiovasc Med (Hagerstown) 2017; 18:733-741. [DOI: 10.2459/jcm.0000000000000552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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33
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The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients. Anatol J Cardiol 2017; 17:258-268. [PMID: 28344214 PMCID: PMC5469105 DOI: 10.14744/anatoljcardiol.2016.7461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The effects of intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation in patients with complex coronary artery lesions remains to be controversial. This study sought to evaluate the outcomes of IVUS guidance in these patients. Methods: The EMBASE, Medline, and other internet sources were searched for relevant articles. The primary endpoint was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularization (TVR). The incidence of definite/probable stent thrombosis (ST) was analyzed as the safety endpoint. Results: Fifteen clinical trials involving 8.084 patients were analyzed. MACE risk was significantly decreased following IVUS-guided DES implantation compared with coronary angiography (CAG) guidance (odds ratio [OR] 0.63, 95% confidence intervals [CI]: 0.53–0.73, p<0.001), which might mainly result from the lower all-cause mortality risk (OR 0.52, 95% CI: 0.40–0.67, p<0.001), MI (OR 0.70, 95% CI: 0.56–0.86, p=0.001), and TVR (OR 0.53, 95% CI: 0.40–0.70, p<0.001). The subgroup analyses indicated better outcomes of IVUS guidance in DES implantation for these patients with left main disease or bifurcation lesions. Conclusion: IVUS guidance in DES implantation is associated with a significant reduction in MACE risk in patients with complex lesions, particularly those with left main disease or bifurcation lesions. More large and powerful randomized trials are still warranted to guide stenting decision making. (Anatol J Cardiol 2017; 17: 258-68)
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Giavarini A, Kilic ID, Redondo Diéguez A, Longo G, Vandormael I, Pareek N, Kanyal R, De Silva R, Di Mario C. Intracoronary Imaging. Heart 2017; 103:708-725. [DOI: 10.1136/heartjnl-2015-307888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Nerlekar N, Cheshire C, Verma K, Ihdayhid AR, McCormick L, Cameron J, Bennett M, Malaiapan Y, Meredith I, Brown A. Intravascular ultrasound guidance improves clinical outcomes during implantation of both first- and second-generation drug-eluting stents: a meta-analysis. EUROINTERVENTION 2017; 12:1632-1642. [DOI: 10.4244/eij-d-16-00769] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Sheth TN, Kajander OA, Lavi S, Bhindi R, Cantor WJ, Cheema AN, Stankovic G, Niemelä K, Natarajan MK, Shestakovska O, Tittarelli R, Meeks B, Jolly SS. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous Coronary Intervention Alone Trial. Circ Cardiovasc Interv 2016; 9:e003414. [PMID: 27056766 DOI: 10.1161/circinterventions.115.003414] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction are at increased risk for adverse events. It is unclear if image guidance by optical coherence tomography (OCT) can improve outcomes in these patients. We compared OCT-guided versus angiography-guided primary PCI for ST-segment-elevation myocardial infarction among patients in the Thrombectomy Versus PCI Alone (TOTAL) trial. METHODS AND RESULTS Among 10 732 patients enrolled in the TOTAL trial, OCT was used for PCI guidance as a part of a prospective substudy in 214 patients. Using 2:1 propensity matching, we identified 428 patients in the trial who had PCI performed with angiography guidance alone. The primary outcome was a composite of cardiovascular death, myocardial infarction, stent thrombosis, and target-vessel revascularization at 1 year. Secondary outcomes included final in-stent angiographic minimum lumen diameter, procedure time, and contrast dose. The final in-stent angiographic minimum lumen diameter was 2.99±0.48 mm in the OCT-guided group versus 2.79±0.47 mm in the angiography-guided group (P<0.0001). OCT- and angiography-guided PCI had a median (interquartile range) procedure time of 58 (47, 71) minute versus 38 (28, 52) minute (P<0.0001) and total contrast dose of 239.7±81.1 mL versus 193.3±78.6 mL (P<0.0001). The primary outcome was observed in 7.5% of the OCT-guided group versus 9.8% of the angiography-guided group (hazard ratio, 0.76; 95% confidence interval, 0.43-1.34; P=0.34). CONCLUSIONS OCT-guided primary PCI for ST-segment-elevation myocardial infarction was associated with a larger final in-stent minimum lumen diameter. There was no significant difference in clinical outcomes at 1 year; however, the study was underpowered to detect a treatment effect. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01149044.
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Affiliation(s)
- Tej N Sheth
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
| | - Olli A Kajander
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Shahar Lavi
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Ravinay Bhindi
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Warren J Cantor
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Asim N Cheema
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Goran Stankovic
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Kari Niemelä
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Madhu K Natarajan
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Olga Shestakovska
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Rachel Tittarelli
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Brandi Meeks
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
| | - Sanjit S Jolly
- From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.)
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37
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Caiazzo G, Mattesini A, Indolfi C, Di Mario C. Bioresorbable Stents. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gianluca Caiazzo
- Division of Cardiology, Department of Medical and Surgical Sciences; Magna Graecia University; Catanzaro Italy
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | | | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences; Magna Graecia University; Catanzaro Italy
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Imperial College London; London UK
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Pathan F, Negishi K. Prediction of cardiovascular outcomes by imaging coronary atherosclerosis. Cardiovasc Diagn Ther 2016; 6:322-39. [PMID: 27500091 DOI: 10.21037/cdt.2015.12.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the last two decades, several invasive and non-invasive coronary atherosclerosis imaging modalities have emerged as predictors of cardiovascular outcomes in at-risk population. These modalities have demonstrated independent or incremental prognostic information over existing/standard risk stratification schemes, such as the Framingham risk score (FRS), by identifying characteristics of coronary artery diseases (CADs). In this review, we begin with discussing the importance of pre-test probability and quality of outcome measure, followed by specific findings of each modality in relation to prognosis. We focused on both short and long term prognostic aspects of coronary computed tomography (CT) (including coronary calcium score and coronary angiography) and magnetic resonance imaging as non-invasive tools, as well as invasive modalities including intravascular ultrasound (IVUS), optical coherence tomography (OCT), near infrared spectroscopy and Angioscopy.
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Affiliation(s)
- Faraz Pathan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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39
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Dangas GD, Giustino G. Can Coronary Stent Implantation Complexity Become an Intuitive and Useful Factor to Tailor DAPT Duration? JACC Cardiovasc Interv 2016; 9:1447-9. [DOI: 10.1016/j.jcin.2016.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
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40
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Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Sansoto T, Chen F, Yuan ZY, Li WM, Leon MB. Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study. JACC Cardiovasc Interv 2016; 8:1335-1342. [PMID: 26315736 DOI: 10.1016/j.jcin.2015.05.017] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs). BACKGROUND The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study. METHODS A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria. RESULTS At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001). CONCLUSIONS Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877).
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Affiliation(s)
- Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Bo Xu
- Beijing Fuwai Cardiovascular Hospital, Beijing, China
| | | | - Imad Sheiban
- San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tak W Kwan
- Beth Israel Hospital, New York, New York
| | | | - Yu-Jie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shu-Zheng Lv
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Ya-Wei Xu
- Shanghai 10th Hospital, Shanghai, China
| | | | - Lang Hong
- Jiangxi Provincial People's Hospital, Nanchang, China
| | | | - Hai-Chang Wang
- Xijing Hospital, Xi'an 4th Military Medical University, Xi'an, China
| | - Tie-Ming Jiang
- Tianjing Policemen Medical College Hospital, Tianjing, China
| | - Yan Wang
- Xia'Men Zhongshan Hospital, Xia'Men, China
| | - Teguh Sansoto
- Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Fang Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zu-Yi Yuan
- Xi'an Communication University Hospital, Xi'an, China
| | - Wei-Min Li
- Haarbin Medical University 1st Hospital, Haarbin, China
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York
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41
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Suwannasom P, Sotomi Y, Ishibashi Y, Cavalcante R, Albuquerque FN, Macaya C, Ormiston JA, Hill J, Lang IM, Egred M, Fajadet J, Lesiak M, Tijssen JG, Wykrzykowska JJ, de Winter RJ, Chevalier B, Serruys PW, Onuma Y. The Impact of Post-Procedural Asymmetry, Expansion, and Eccentricity of Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting Stent on Clinical Outcomes in the ABSORB II Trial. JACC Cardiovasc Interv 2016; 9:1231-1242. [DOI: 10.1016/j.jcin.2016.03.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
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Mahmud E, Ramsis M, Behnamfar O, Enright K, Huynh A, Kaushal K, Palakodeti S, Li S, Teh P, Lin F, Reeves R, Patel M, Ang L. Effect of Serum Fibrinogen, Total Stent Length, and Type of Acute Coronary Syndrome on 6-Month Major Adverse Cardiovascular Events and Bleeding After Percutaneous Coronary Intervention. Am J Cardiol 2016; 117:1575-1581. [PMID: 27040574 DOI: 10.1016/j.amjcard.2016.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
Abstract
This study evaluated the relation between baseline fibrinogen and 6-month major adverse cardiovascular events (MACE) and bleeding after percutaneous coronary intervention (PCI). Three hundred eighty-seven subjects (65.6 ± 16.1 years, 69.5% men, 26.9% acute coronary syndrome [ACS]) who underwent PCI with baseline fibrinogen and platelet reactivity (VerifyNow P2Y12 assay, Accumetrics, San Diego, California) measured were enrolled. Fibrinogen (368.8 ± 144.1 vs 316.8 ± 114.3 mg/dl; p = 0.001), total stent length (TSL; 44.5 ± 25.0 vs 32.2 ± 20.1 mm; p <0.001), and ACS presentation (40.6% vs 23.9%; p = 0.005) were independently associated with 6-month MACE rates (17.8%: myocardial infarction 9.8%, rehospitalization for ACS 3.6%, urgent revascularization 3.6%, stroke 0.5%, and death 0.3%). Measures of platelet reactivity were not associated with 6-month MACE. After multivariate analysis, fibrinogen ≥280 mg/dl (odds ratio [OR] 2.60, 95% CI 1.33 to 5.11, p = 0.005), TSL ≥32 mm (OR 3.21, 95% CI 1.82 to 5.64, p <0.001), and ACS presentation (OR 2.58, 95% CI 1.45 to 4.61, p = 0.001) were associated with higher 6-month MACE. In 271 subjects receiving chronic P2Y12 inhibitor therapy, 6-month Thrombolysis In Myocardial Infarction bleeding after PCI was 7.0%, but no difference in fibrinogen level (338.3 ± 109.7 vs 324.3 ± 113.8 mg/dl, p = 0.60) stratified by Thrombolysis In Myocardial Infarction bleeding was observed. In conclusion, elevated serum fibrinogen, ACS presentation, and longer TSL are independently associated with higher 6-month MACE after PCI, whereas no association with on-thienopyridine platelet reactivity and 6-month MACE was observed. Post-PCI bleeding was not associated with lower fibrinogen level.
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Affiliation(s)
- Ehtisham Mahmud
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
| | - Mattheus Ramsis
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Omid Behnamfar
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Kelly Enright
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Andrew Huynh
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Khushboo Kaushal
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Samhita Palakodeti
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Shiqian Li
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Phildrich Teh
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Felice Lin
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Ryan Reeves
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Mitul Patel
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Lawrence Ang
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
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Lai CH, Lee WL, Sung SH, Hsu PF, Chen YH, Chan WL, Lin SJ, Lu TM. Comparison of Bare-Metal Stent and Drug-Eluting Stent for the Treatment of Patients Undergoing Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease - Long-Term Result from a Single Center Experience. ACTA CARDIOLOGICA SINICA 2016; 31:381-9. [PMID: 27122897 DOI: 10.6515/acs20140630g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has become an alternative treatment for left main (LM) coronary artery disease. The aim of our study was to compare long-term clinical outcomes of patients undergoing unprotected LM PCI with bare-metal stent (BMS) or drug-eluting stent (DES) in a high-risk population. METHODS AND RESULTS We enrolled 223 consecutive patients with unprotected LM coronary artery disease undergoing PCI (mean age: 71.1 ± 11.2 years, 187 male), including 94 patients receiving BMS and 129 patients receiving DES. The patients receiving DES had a significantly higher SYNTAX score (p = 0.05). During the mean follow-up period of 2.5 years, there were 31 cardiovascular deaths (BMS: 21 cases, DES: 10 cases, p = 0.04 by log-rank test), 56 major adverse cardiovascular events (MACE, including cardiovascular death, non-fatal myocardial infarction (MI) and clinical-driven target lesion revascularization; BMS: 33 cases, DES: 23 cases, p = 0.03 by log-rank test) and 6 cases with definite/probable stent thrombosis (BMS: 5 cases, DES: 1 cases, p = 0.09). In multivariate Cox analysis, the use of DES was identified as an independent protective factor against cardiovascular death [hazard ratio (HR) = 0.34, 95% confidence interval (Cl) = 0.15-0.79, p = 0.01] and MACE (HR = 0.50, 95% CI = 0.28-0.88, p = 0.02). The clinical outcome analyses in propensity-score matched the cohort (87 matched pair of patients receiving BMS and DES) and yielded similar results. CONCLUSIONS In the general practice among a high-risk population undergoing unprotected LM PCI, the use of DES appeared to be beneficial in reducing the risk of long-term cardiovascular death and MACE. KEY WORDS Bare-mental stent; Drug-eluting stent; Left main coronary artery disease; Percutaneous coronary intervention.
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Affiliation(s)
- Chih-Hung Lai
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University
| | - Wen-Lieng Lee
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University
| | - Shih-Hsien Sung
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pai-Feng Hsu
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Hwa Chen
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing-Jong Lin
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Steinvil A, Zhang YJ, Lee SY, Pang S, Waksman R, Chen SL, Garcia-Garcia HM. Intravascular ultrasound-guided drug-eluting stent implantation: An updated meta-analysis of randomized control trials and observational studies. Int J Cardiol 2016; 216:133-9. [PMID: 27153138 DOI: 10.1016/j.ijcard.2016.04.154] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
The use of intravascular ultrasound (IVUS) guidance for drug-eluting stent (DES) optimization is limited by the number of adequately powered randomized control trials (RCTs). We performed an updated meta-analysis, including data from recently published RCTs and observational studies, by reviewing the literature in Medline and the Cochrane Library to identify studies that compared clinical outcomes between IVUS-guided and angiography-guided DES implantation from January 1995 to January 2016. This meta-analysis included 25 eligible studies, including 31,283 patients, of whom 3192 patients were enrolled in 7 RCTs. In an analysis of all 25 studies, the summary results for all the events analyzed were significantly in favor of IVUS-guided DES implantation [major adverse cardiac events (MACE, odds ratio [OR] 0.76, 95% confidence intervals [CI]: 0.70-0.82, P<0.001); death (OR 0.62, 95% CI: 0.54-0.72, P<0.001); myocardial infarction (OR 0.67, 95% CI: 0.56-0.80, P<0.001); stent thrombosis (OR 0.58, 95% CI: 0.47-0.73, P<0.001); target lesion revascularization (TLR, OR 0.77, 95% CI: 0.67-0.89, P=0.005); target vessel revascularization (TVR, OR 0.85, 95% CI: 0.76-0.95, P<0.001)]. However, in a separate analysis of RCTs, a favorable result for IVUS-guided DES implantation was found only for MACE (OR 0.66, 95% CI: 0.52-0.84, P=0.001), TLR (OR 0.61, 95% CI: 0.43-0.87, P=0.006), and TVR (OR 0.61, 95% CI: 0.41-0.90, P=0.013). IVUS-guided percutaneous coronary intervention was associated with better overall clinical outcomes than angiography-guided DES implantation. However, in a solely RCT meta-analysis, this benefit was mainly driven by reduced rates of revascularizations.
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Affiliation(s)
- Arie Steinvil
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Yao-Jun Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Sang Yeub Lee
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Si Pang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA.
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Alberti A, Giudice P, Gelera A, Stefanini L, Priest V, Simmonds M, Lee C, Wasserman M. Understanding the economic impact of intravascular ultrasound (IVUS). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:185-193. [PMID: 25669755 DOI: 10.1007/s10198-015-0670-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
AIMS To examine the cost-effectiveness of intravascular ultrasound (IVUS) use during percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in treating coronary artery disease (CAD). METHODS AND RESULTS A Markov model was constructed with a lifetime horizon to compare costs and health outcomes between IVUS-guided PCI and PCI guided solely by angiography from an Italian healthcare payer perspective. The population examined included CAD patients undergoing PCI with DES. From a healthcare payer perspective, the resulting incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year was negative in the base-case scenario (i.e., IVUS benefit assumed to persist beyond the first year). When IVUS benefit was assumed to be limited to the first year, the ICER increased to €9,624. This conclusion remained consistent even when scenarios varied regarding the duration of the device's effect. Furthermore, benefits of using IVUS were greater for patients with acute coronary syndrome, renal insufficiency, and diabetes. CONCLUSIONS Using IVUS with angiography is a dominant strategy in Italy, and results demonstrate that it is desirable to target those at a greater risk of restenosis (i.e., patients with diabetes, chronic kidney disease, and acute coronary syndrome), who tend to benefit more from accurate stent implantation. Further information is necessary regarding the long-term benefits of IVUS, however sensitivity analysis presented in this research demonstrates a strong argument supporting the cost-effectiveness of IVUS.
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Affiliation(s)
| | - Pietro Giudice
- San Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
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46
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Kim IC, Yoon HJ, Shin ES, Kim MS, Park J, Cho YK, Park HS, Kim H, Nam CW, Han SW, Kim YN, Kim KB, Hur SH. Usefulness of Frequency Domain Optical Coherence Tomography Compared with Intravascular Ultrasound as a Guidance for Percutaneous Coronary Intervention. J Interv Cardiol 2016; 29:216-24. [PMID: 26927366 DOI: 10.1111/joic.12276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare outcomes and rates of optimal stent placement between optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI). BACKGROUND Unlike IVUS-guided PCI, rates of clinical outcomes and optimal stent placement have not been well characterized for OCT-guided PCI. METHODS The study enrolled 290 patients who underwent implantation of a second generation drug eluting stent under OCT (122 patients) or IVUS (168 patients) guidance. The two groups were compared after adjusting for baseline differences using 1:1 propensity score matching (PSM) (114 patients in each group). Optimal stent placement was defined as achieving an adequate lumen (optimal minimum stent area [MSA > 4.85 mm(2) for OCT, >5 mm(2) for IVUS] or a final MSA ≥ 90% of the distal reference lumen area, without edge dissection, incomplete stent apposition, or tissue prolapse), or otherwise performing additional interventions to address suboptimal post-stenting OCT or IVUS findings. The primary endpoint was one-year cumulative incidence of major adverse cardiac events (MACE; cardiac death, myocardial infarction and target lesion revascularization). Definite or probable stent thrombosis (ST) rates were evaluated. RESULTS In adjusted comparisons between OCT and IVUS groups, there was no significant difference in rates of MACE (3.5% vs. 3.5%, P = 1.000) and ST (0% vs. 0.9%, P = 1.000) at 1 year, optimal stent placement (89.5% vs. 92.1%, P = 0.492), and further intervention (7.9% vs.13.2%, P = 0.234), despite OCT significantly more frequently detecting tissue prolapse (97.4% vs. 47.4%, P < 0.001), and numerically more edge dissection (10.5% vs. 4.4%, P = 0.078) or incomplete stent apposition (48.2% vs. 36.8%, P = 0.082). CONCLUSIONS OCT guidance showed comparable results to IVUS in mid-term clinical outcomes, suggesting that OCT can be an alternative tool for stent placement optimization.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Min-Seok Kim
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Jincheol Park
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Wook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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Hyeon SH, Lee WS, Kim DI, Shin ES, Kim KS, Hong YJ, Lee SY, Won H, Kim TH, Kim SW. A Comparison of Intravascular Imaging Modalities for Detection of Stent Struts in Acute Coronary Syndrome. J Interv Cardiol 2016; 29:99-107. [PMID: 26864953 DOI: 10.1111/joic.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We used optical coherence tomography (OCT) and intravascular ultrasound (IVUS) to assess the struts of implanted stents in patients with acute coronary syndrome (ACS). METHODS A totle of 10,756 stent struts were analyzed with OCT in 42 patients of ACS. Of them, both of IVUS and OCT imaging were performed in 33 patients. Appearance of stent struts was classified as well apposed, buried, malapposed, and nondetectable, and the number of stent struts were counted by OCT and IVUS was compared. RESULTS Most of stent struts were well apposed (78.1%, 8,407/10,756). However, malapposed struts were 5.6% (607/10,756), and 14.1% (1,514/10,756) of stent struts were buried by thrombus. The nondetectable struts were 2.11% (228/10,756) in ACS. 94.7% (216/228) of nondetectable stent struts were associated with red thrombus, and plaque prolapse was in 5.3% (12/228). The number of stent struts counted by OCT were larger than that of IVUS. The mean number of stent struts at the proximal and distal stent edges were 24 ± 6.57 in OCT, the stent struts IVUS counted were 20 ± 4.18 (P < 0.0001). Although the frequency of malapposed struts were similar 4.6% (376/8,248) in OCT versus 4.8% (369/7,674) in IVUS (P = 0.788). Stent struts were often buried by thrombus in ACS 15.2% (1,252/8,248) in OCT versus 9.7% (747/7,674) in IVUS; P = 0.006. The nondetectable struts were fewer in IVUS than OCT 0.2% (16/7,674) in IVUS versus 2.2% (187/8,248) in OCT; P < 0.0001. CONCLUSION Stent struts are frequently buried and nondetectable due to thrombi burden in ACS patients. Adequate thrombus removal and proper selection of the imaging device is warranted in ACS.
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Affiliation(s)
- Seong Hyeop Hyeon
- Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul, Korea
| | - Wang Soo Lee
- Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul, Korea
| | - Doo Il Kim
- Cardiovascular Center, Inje University Paik Hospital, Busan & Goyang, Korea
| | - Eun Seok Shin
- Cardiovascular Center, Ulsan University Hospital, Ulsan, Korea
| | - Ki Seok Kim
- Cardiovascular Center, Jeju National University Hospital, Jeju, Korea
| | - Young Joon Hong
- Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Yun Lee
- Cardiovascular Center, Inje University Paik Hospital, Busan & Goyang, Korea
| | - Hoyoun Won
- Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul, Korea
| | - Tae Ho Kim
- Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul, Korea
| | - Sang-Wook Kim
- Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul, Korea
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Frimerman A, Abergel E, Blondheim DS, Shotan A, Meisel S, Shochat M, Punjabi P, Roguin A. Novel Method for Real Time Co-Registration of IVUS and Coronary Angiography. J Interv Cardiol 2016; 29:225-31. [DOI: 10.1111/joic.12279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aharon Frimerman
- Department of Cardiology; Hillel-Yaffe Medical Center; Hadera 38100 Israel
| | - Eitan Abergel
- Department of Cardiology; Rambam Medical Center; Rappaport Faculty of Medicine, Technion- Israel Institute of Technology; Haifa 3109601 Israel
| | - David S. Blondheim
- Department of Cardiology; Hillel-Yaffe Medical Center; Hadera 38100 Israel
| | - Avraham Shotan
- Department of Cardiology; Hillel-Yaffe Medical Center; Hadera 38100 Israel
| | - Simcha Meisel
- Department of Cardiology; Hillel-Yaffe Medical Center; Hadera 38100 Israel
| | - Michael Shochat
- Department of Cardiology; Hillel-Yaffe Medical Center; Hadera 38100 Israel
| | - Pritesh Punjabi
- Department of Cardiology; Rambam Medical Center; Rappaport Faculty of Medicine, Technion- Israel Institute of Technology; Haifa 3109601 Israel
| | - Ariel Roguin
- Department of Cardiology; Rambam Medical Center; Rappaport Faculty of Medicine, Technion- Israel Institute of Technology; Haifa 3109601 Israel
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Kubo T, Shinke T, Okamura T, Hibi K, Nakazawa G, Morino Y, Shite J, Fusazaki T, Otake H, Kozuma K, Akasaka T. Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): Study protocol for a randomized controlled trial. J Cardiol 2016; 68:455-460. [PMID: 26763605 DOI: 10.1016/j.jjcc.2015.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/02/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Optical coherence tomography is becoming increasingly widespread as an adjunctive intravascular diagnostic technique in percutaneous coronary intervention (PCI), because of its ability to visualize coronary structures at high resolution. Several studies have reported that intravascular ultrasound (IVUS) guidance in PCI might be helpful to reduce subsequent stent thrombosis, restenosis, repeat revascularization, myocardial infarction, and cardiac death. The OPtical frequency domain imaging vs. INtravascular ultrasound in percutaneous coronary InterventiON (OPINION) trial is aimed at evaluating the impact of optical frequency domain imaging (OFDI) guidance in PCI on clinical outcomes compared with IVUS guidance. METHODS AND DESIGN The OPINION trial is a multicenter, prospective, randomized, controlled, open-label, parallel group, non-inferiority trial in Japan. The eligible patients are randomly assigned to receive either OFDI-guided PCI or IVUS-guided PCI. PCI is performed using the biolimus-eluting stent in accordance with a certain criteria of OFDI and IVUS for optimal stent deployment. All patients will undergo a follow-up angiography at 8 months. The primary endpoint is target vessel failure composed of cardiac death, myocardial infarction attributed to the target vessel, and clinically-driven target vessel revascularization at 12 months. CONCLUSION When completed, the OPINION trial will contribute to define the clinical value of the OFDI guidance in PCI.
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshiro Shinke
- Department of Internal Medicine, Division of Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Iwate Medical University, Morioka, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tetsuya Fusazaki
- Division of Cardiology, Iwate Medical University, Morioka, Japan
| | - Hiromasa Otake
- Department of Internal Medicine, Division of Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken Kozuma
- Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
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