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Yamamoto K, Shiomi H, Morimoto T, Miyazawa A, Watanabe H, Nakamura S, Suwa S, Domei T, Ono K, Sakamoto H, Shigetoshi M, Taniguchi R, Okayama H, Toyota T, Yokomatsu T, Muto M, Kawaguchi R, Kishi K, Hadase M, Fujita T, Nishida Y, Nishino M, Otake H, Natsuaki M, Watanabe H, Suematsu N, Tanabe K, Abe M, Hibi K, Kadota K, Ando K, Kimura T. Single-Session Versus Staged Multivessel Optimal IVUS-Guided PCI in Patients With CCS or NSTE-ACS. JACC Asia 2023; 3:649-661. [PMID: 37614540 PMCID: PMC10442883 DOI: 10.1016/j.jacasi.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 08/25/2023]
Abstract
Background There are no studies comparing single-session vs staged multivessel intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS) or non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Objectives The authors aimed to compare single-session vs staged multivessel IVUS-guided PCI in patients with CCS or NSTE-ACS. Methods The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,021 patients with CCS or NSTE-ACS undergoing multivessel PCI including left anterior descending coronary artery using IVUS aiming to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared single-session vs staged multivessel PCI. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. Results There were 246 patients (24.1%) undergoing single-session multivessel PCI, and 775 patients (75.9%) undergoing staged multivessel PCI. There was a wide variation in the prevalence of single-session multivessel PCI across the participating centers. The staged multivessel PCI group more often had complex coronary anatomy such as 3-vessel disease, chronic total occlusion, and calcified lesions requiring an atherectomy device compared with the single-session multivessel PCI group. The rates of PCI success, procedural complications, and meeting OPTIVUS criteria were not different between groups. The cumulative 1-year incidence of the primary endpoint was not different between single-session and staged multivessel PCI groups (9.0% vs 10.8%, log-rank P = 0.42). After adjusting confounders, the effect of single-session multivessel PCI relative to staged multivessel PCI was not significant for the primary endpoint (HR: 0.95; 95% CI: 0.58-1.55; P = 0.84). Conclusions Single-session and staged multivessel IVUS-guided PCI had similar 1-year outcomes.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Masataka Shigetoshi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Masahiro Muto
- Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Ren Kawaguchi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Tsutomu Fujita
- Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Sapporo, Japan
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuhiro Suematsu
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - OPTIVUS-Complex PCI Investigators
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
- Cardiocore Japan, Tokyo, Japan
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
- Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
- Department of Cardiology, Saiseikai Shiga Hospital, Ritto, Japan
- Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Sapporo, Japan
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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Yamamoto K, Shiomi H, Morimoto T, Watanabe H, Miyazawa A, Yamaji K, Ohya M, Nakamura S, Mitomo S, Suwa S, Domei T, Tatsushima S, Ono K, Sakamoto H, Shimamura K, Shigetoshi M, Taniguchi R, Nishimoto Y, Okayama H, Matsuda K, Yokomatsu T, Muto M, Kawaguchi R, Kishi K, Hadase M, Fujita T, Nishida Y, Nishino M, Otake H, Tanabe K, Abe M, Hibi K, Kadota K, Ando K, Kimura T. Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease. JACC Asia 2023; 3:211-225. [PMID: 37181400 PMCID: PMC10167516 DOI: 10.1016/j.jacasi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 05/16/2023]
Abstract
Background Intravascular ultrasound (IVUS) was only rarely used in landmark trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel disease. Objectives The authors aimed to evaluate clinical outcomes after optimal IVUS-guided PCI in patients undergoing multivessel PCI. Methods The OPTIVUS (OPTimal IntraVascular UltraSound)-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified criteria (OPTIVUS criteria: minimum stent area > distal reference lumen area [stent length ≥28mm], and minimum stent area >0.8 × average reference lumen area [stent length <28mm]) for optimal stent expansion. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) (death/myocardial infarction/stroke/any coronary revascularization). The predefined performance goals were derived from the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome study in Kyoto) PCI/CABG registry cohort-2 fulfilling the inclusion criteria in this study. Results In this study, 40.1% of the patients met OPTIVUS criteria in all stented lesions. The cumulative 1-year incidence of the primary endpoint was 10.3% (95% CI: 8.4%-12.2%), which was significantly lower than the predefined PCI performance goal of 27.5% (P < 0.001), and which was numerically lower than the predefined CABG performance goal of 13.8%. The cumulative 1-year incidence of the primary endpoint was not significantly different regardless of meeting or not meeting OPTIVUS criteria. Conclusions Contemporary PCI practice conducted in the OPTIVUS-Complex PCI study multivessel cohort was associated with a significantly lower MACCE rate than the predefined PCI performance goal, and with a numerically lower MACCE rate than the predefined CABG performance goal at 1 year.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shojiro Tatsushima
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Masataka Shigetoshi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kensho Matsuda
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | - Masahiro Muto
- Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Ren Kawaguchi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Tsutomu Fujita
- Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Sapporo, Japan
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - OPTIVUS-Complex PCI Investigators
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- Cardiocore Japan, Tokyo, Japan
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
- Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
- Department of Cardiology, Saiseikai Shiga Hospital, Ritto, Japan
- Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Sapporo, Japan
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
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