IVUS-guided PCI Research Articles

Association between stent implantation results and target vessel failure after IVUS-Guided PCI: A FLAVOUR substudy

Abstract Background Despite substantial advancements in coronary stent systems and implantation techniques, target vessel failure (TVF) remains a clinical issue to be addressed. Purpose We used deep learning algorithms for automatic stent analysis of intravascular ultrasound (IVUS) data to identify stent implantation characteristics associated with TVF. Methods In patients from the IVUS-guided group of the FLAVOUR trial who had undergone successful stenting, validated deep learning algorithms were applied to IVUS images to delineate plaque and stent strut for the quantification of stent expansion, apposition, and residual plaque burden. Stent overexpansion was defined as stent area exceeding 120% of the hypothetical healthy lumen area. Murray law-based quantitative flow ratio (μQFR) was also assessed from angiographic images. The primary endpoint was TVF at 2 years, defined as a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. Results A total of 459 vessels in 441 patients were included, with TVF events occurred in 15 vessels (3.3%) during the 2-year follow-up. Stent analysis was performed in 687,379 stent struts from 70,369 IVUS image frames of the interrogated vessels with the assistance of specific deep learning algorithms. On vessel-level multivariate analysis adjusting for procedural covariates, stent overexpansion length >5 mm (hazard ratio, 4.57; 95% confidence interval [CI], 1.31 to 15.92; P=0.017), residual plaque burden at proximal stent edge >50% (hazard ratio, 3.34; 95% CI, 1.19 to 9.33; P=0.022), and post-PCI μQFR <0.90 (hazard ratio, 5.09; 95% CI, 1.62 to 15.97; P=0.005) were more likely to be present in vessels with TVF events than in those without. Conclusions Besides the established indexes of post-procedural residual plaque burden and low μQFR, deep learning-powered IVUS stent overexpansion was significantly associated with increased risk of TVF.Suboptimal stenting results and TVF

Comparison of intravascular ultrasound-guided with optical coherence tomography-guided percutaneous coronary intervention for left main distal bifurcation lesions: Rationale and design of the ISOLEDS trial

BackgroundPercutaneous coronary intervention (PCI) can provide benefits for anatomically suitable left main coronary artery (LMCA) lesions. When compared to traditional coronary angiography (CAG) -guided PCI, the use of intravascular ultrasound (IVUS) guidance has shown significant long-term prognostic improvements in LMCA PCI. Optical coherence tomography (OCT) offers a higher axial resolution than IVUS. However, there is currently a lack of relevant randomized controlled trials investigating the use of OCT specifically for left main distal bifurcation lesions. MethodsThe ISOLEDS trial is an ongoing multicenter study that aims to compare IVUS-guided PCI with OCT-guided PCI for patients with true LMCA distal bifurcation lesions. This prospective, randomized, controlled, non-inferiority trial will enroll a total of 664 patients with visually-defined Medina 1,1,1 or 0,1,1 classification of left main distal bifurcation lesions. The patients will be randomly assigned in a 1:1 ratio to either IVUS-guided or OCT-guided PCI. The primary endpoint is to assess the occurrence of target lesion failure (TLF) within 12 months after the procedure. After undergoing PCI, patients are required to visit the hospital for a 12-month clinical follow-up. During this clinical assessment, CAG can be performed to evaluate the status of target lesions. DiscussionThe ISOLEDS trial represents the first attempt to compare two distinct intracoronary imaging techniques for guiding PCI in patients with true LMCA distal bifurcation lesions. By evaluating and comparing the outcomes of these two imaging techniques, the trial results will aid operators in selection of the most effective approach for guiding PCI in these patients.

D-46 | IVUS-Guided Ultralow-Contrast PCI in Patients with CKD and Reduced Ejection Fraction: Safety Outcomes Analysis

D-46 | IVUS-Guided Ultralow-Contrast PCI in Patients with CKD and Reduced Ejection Fraction: Safety Outcomes Analysis

Rationale and design of a comparison of angiography-derived fractional flow reserve-guided and intravascular ultrasound-guided intervention strategy for clinical outcomes in patients with coronary artery disease: a randomised controlled trial (FLAVOUR II)

IntroductionPercutaneous coronary intervention (PCI) guided by coronary angiography-derived fractional flow reserve (FFR) or intravascular ultrasound (IVUS) has shown improved clinical outcomes compared with angiography-only-guided PCI. In patients with intermediate stenoses,...

Characterization of lipidic coronary atheroma under control of low-density lipoprotein <1.8 mmol/l and lipoprotein (a) <50 mg/dl in patients with coronary artery disease

Abstract Background Lp(a) has been considered as a potential therapeutic target associated with atherosclerosis. In particular, Lp(a) ≧50 mg/dL has been shown to predict an elevated cardiovascular risk even under lowering LDL-C level, indicating that lowering of both LDL-C and Lp(a) may be more beneficial to halt atherogenesis. However, atherosclerotic features with favorable control of these lipid targets have not been fully characterized yet. The REASSURE-NIRS registry (NCT04864171) is an on-going multi-center registry which enrolls CAD patients receiving near-infrared spectroscopy (NIRS)/IVUS-guided PCI in Japan. Given that NIRS enables to quantitatively evaluate lipidic plaque materials, this registry provides an opportunity to investigate lipidic plaque features in association with LDL-C and Lp(a) levels. Objectives The aim of this study was to elucidate NIRS-derived characteristics of coronary atheroma in patients with CAD who exhibited both LDL-C<1.8 mmol/L and Lp(a) <50 mg/dL. Methods From the REASSURE-NIRS registry (n=1013), we investigated 549 culprit lesions in 498 patients with measurement of both LDL-C and Lp(a) levels at the index of PCI. Maximum 4-mm lipid core burden index (max LCBI4mm) at culprit lesions were measured with NIRS imaging prior to PCI. Study subjects were stratified into 4 groups according to LDL-C and Lp(a) levels: LDL-C<1.8mmol/L and Lp(a)<50mg/dL, LDL-C≧1.8mmol/ and Lp(a)<50mg/dL, LDL-C<1.8mmol/L and Lp(a)≧50mg/dL, LDL-C≧1.8mmol/L and Lp(a)≧50mg/dL. Clinical characteristics and max LCBI4mm were compared in 4 groups. Results In the current study, 30.6% of patients was ACS. Under the use of lipid-lowering therapies (statin: 68.4% and high-intensity statin: 26.0%), 33.1% of study population exhibited both LDL-C<1.8mmol/L and Lp(a)<50mg/dL. Patients with LDL-C<1.8mmol/L and Lp(a)<50mg/dL were more likely to be male (p=0.002) and smoker (p=0.002) and have a history of previous MI (p<0.001). As expected, statin was more frequently used in those with both LDL-C<1.8mmol/L and Lp(a)<50mg/dL (p<0.001). On NIRS imaging analysis, patients with low LDL-C<1.8mmol/L and Lp(a)<50mg/dL were associated with significantly lower max LCBI4mm (Figure). Of note, even in patients with LDL-C<1.8mmol/L, max LCBI4mm was lower in those achieving Lp(a) <50 mg/dL compared to those with Lp(a) ≧50 mg/dL (p=0.001). Multivariate analysis adjusting for ACS, LDL-C levels and statin use, Lp(a) levels revealed emerged as independent predictor of maxLCBI4mm (β=1.0, 95%CI: 0.06 to 2.04, p=0.04). Conclusion Patients with LDL-C<1.8mmol/L and Lp(a)<50mg/dL more likely exhibited a smaller amount of lipidic plaque materials on NIRS imaging. Our findings support that lowering both LDL-C and Lp(a) may be more beneficial to modulate lipidic plaque component, which ultimately results in the further reduction of ASCVD risks.Comparison of clinical characteristics

Abstract 18201: Intracoronary Optical Coherence Tomography versus Intravascular Ultrasound in ST and Non-ST Elevation Myocardial Infarction: A Nation-Wide Analysis

Introduction: Intravascular ultrasound (IVUS) and intracoronary optical coherence tomography (OCT) are the 2 techniques of intracoronary imaging that are currently accessible modalities to precisely measure coronary diameters and characterize morphology of lesions. We aimed to compare the impact of IVUS and OCT on outcomes and 30-day readmission rates following STEMI and NSTEMI. Methods: We queried the National Readmission database (2010-2019) to identify patients with STEMI and NSTEMI, undergoing PCI and compared outcomes and 30-day readmission rates between patients undergoing IVUS-guided PCI and OCT-guided PCI. Multivariable logistic regression was performed to evaluate the odds ratios (OR) of adverse outcomes in the 2 groups Results: Of 67,479 STEMI admissions undergoing ICI-guided PCI, 65,137 underwent IVUS and 2,342 underwent OCT. Patients undergoing OCT compared to IVUS had lower Length of stay (LOS) (OR 0.98 [0.96-0.99], P<0.05). However, there was no significant difference in in-hospital mortality, 30-day readmission rate and 90-day readmission rate. Of 103,901 NSTEMI admissions undergoing ICI-guided PCI, 100,127 underwent IVUS and 3774 underwent OCT. Patients undergoing OCT compared to IVUS had lower LOS (OR 0.95 [0.93-0.98], P<0.001) and 30-day readmission rates (OR 0.84 [0.71-0.99], P<0.05), but no significant differences were found in in-hospital mortality and 90-day readmission rates Conclusions: In acute MI patients undergoing ICI-guided PCI, OCT-guided PCI during index hospitalization is associated with similar outcomes compared to IVUS-guided PCI (except better LOS and 30-day readmission rates in NSTEMI).

Outcomes of Optical Coherence Tomography Compared with Intravascular Ultrasound to Guide Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Control Trials

In the recent years, the alternative intravascular imaging modalities that are most frequently employed to direct and optimize PCI have been intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The comparative effectiveness of OCT-guided vs IVUS-guided PCI is still up for debate. The purpose of this study was to conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus intravascular ultrasound (IVUS)-guided PCI. Electronic journals searching were performed in PubMed, ScienceDirect, and Cochrane from January 2015 to March 2023 to identify randomized control trial (RCT) studies that compare OCT‐guided PCI to IVUS‐guided PCI. Meta-analyses were performed on included studies and Odds ratio (OR) and 95% Confidence Interval (CI) were estimated using Review Manager v5.4. A total of four RCT enrolling 1316 participants were included in our analysis. There is no statistical significance was observed in the OCT versus IVUS comparison on all cause mortality [OR = 1.75, 95% CI (0.52, 5.88), p = 0.37], cardiovascular mortality [OR = 1.40, 95% CI (0.27, 7.11), p = 0.69], MACE [OR = 1.04, 95% CI (0.63, 1.71), p = 0.88], ST [OR = 0.94, 95% CI (0.16, 5.52), p = 0.95], TLR [OR = 0.77, 95% CI (0.39, 1.50), p = 0.44], and TVR [OR = 1.19, 95% CI (0.68, 2.07), p = 0.54].

The principles of ultra-low contrast percutaneous coronary intervention

Ultra-low contrast percutaneous coronary intervention (ULCPCI) can be performed electively in advanced chronic kidney disease. Engage guide catheter and advance guidewire into the coronary artery without using contrast. IVUS-guided PCI can reduce the contrast load. Perform co-registration of distal and proximal radio-opaque marker bands of intravascular ultrasound (IVUS) catheter. Deploy the stent at the target lesion under fluoroscopic guidance of these co-registered position of the IVUS-marking images. Complete the ULCPCI procedure with a final angiography using minimal contrast. Newer contrast sparing techniques and intravascular imaging technologies provide opportunities to perform ULCPCI efficiently with good results and the least complications.

Abstract 11770: Clinical Outcomes of Optical Coherence Tomography-Guided Compared With Intravascular Ultrasound-Guided in Low-Risk Percutaneous Coronary Intervention: A Meta-Analysis

Background: Axial resolution provided by optical coherence tomography (OCT) is 10 times higher compared with intravascular ultrasound (IVUS), hence OCT could detect fine details such as edge dissections and tissue coverage of stent struts which may be missed by IVUS imaging. Given the lack of robust comparative data, utilization of IVUS or OCT in PCI guidance is mainly based on the operator experience. Recently, multiple studies have compared clinical outcomes between OCT-guided versus IVUS-guided in PCI, thus we performed this meta-analysis. Methods: We conducted a meta-analysis of all studies evaluating the clinical outcomes of OCT-guided versus IVUS-guided in low-risk PCI. Studies that included patients with left main disease, bifurcation lesions, long lesions, in-stent stenosis, and patients with history of coronary artery bypass grafting were all excluded. Our primary outcome was major cardiac adverse events (MACE). Secondary outcomes consisted of all-cause death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR). Results: Four RCTs and one propensity-matched observational study were included, with a total of 1,544 patients and a median weighted follow-up period of 1.26 years. Out of the total population, 51% were in the OCT arm and 49% in the IVUS arm. Our pooled analysis showed a similar risk of MACE (OCT 5.0% vs IVUS 4.7%, p=0.90), risk of all-cause death (OCT 2.7% vs IVUS 1.7%, p=0.44), MI (OCT 1.5% vs IVUS 1.3%, p=0.76), ST (OCT 0.3% vs IVUS 0.4%, p=0.66) and TLR (OCT 2.2% vs IVUS 2.6%, p=0.58) between the two groups (Figures 1). Heterogeneity was low in all outcomes (I 2 =0). Conclusion: OCT-guided PCI has similar long term clinical outcomes when compared to IVUS-guided PCI in low-risk patients. RCTs with a larger population and longer follow-up periods are needed to confirm these results.

Clinical impact of intravascular ultrasound guidance in patients of ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug eluting stent

Abstract Background There is little data about clinical role of intravascular ultrasound (IVUS)-guided Percutaneous (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI). Methods From 2005 to 2018, a total of 8,129 patients who underwent PCI with STEMI were investigated from the Korea Acute Myocardial Infarction Registry-National Institute of Health database. Patients with Non-ST segment elevation myocardial infarction, cardiogenic shock, bare metal stent implantation, thrombolytic treatment, and coronary artery bypass graft surgery were excluded. We categorized patients into two groups based on the treatment strategy: IVUS-guided PCI group (n=1,544), and coronary angiography guidance (CAG)-guided PCI group (n=6,585). The primary endpoint was composite of major adverse cardiovascular (MACE), including, cardiac death, myocardial infarction (MI), repeat target vessel revascularization (TVR) and stent thrombosis (ST). Results IVUS-guided PCI was performed in 19% patients (1544/8129). After propensity score matching, there were no statistically difference in the rate of cardiac death (0% in IVUS vs. 0.26% in CAG, p=0.947), MI (2.01% vs. 2.01%, p=0.408), TVR (1.23% vs. 0.91%, p=0.131), ST (0.32% vs. 0.45%, p=0.828) and composite of MACE at 1 year between two groups (2.01% vs. 2.40%, p=0.843). Independent risk factors for MACE were diabetes mellitus and multi-vessel disease, but not IVUS-guided PCI (HR 1.167, 95% CI, 0.896–1.520, p=0.251). Conclusion This study suggests that routine usage of IVUS in the setting of STEMI may not be necessary. Large-scaled random study will be needed for further evaluation. Funding Acknowledgement Type of funding sources: None.

Association between coronary artery calcium score and stent expansion in percutaneous coronary intervention

BackgroundMeasurement of the coronary artery calcification score using multidetector computed tomography (MDCT) is a useful noninvasive test for the diagnosis of coronary artery disease. However, whether pre-intervention assessment of the target vessel coronary artery calcification (TV-CAC) score is associated with stent expansion failure and future target lesion revascularization (TLR), remains unknown. This study aimed to determine the association between the TV-CAC score measured by MDCT and stent expansion rate in patients who underwent IVUS-guided PCI for stable angina. MethodsWe conducted a retrospective observational study including 135 consecutive patients (186 target lesions) who underwent MDCT and were scheduled for the first PCI. The patients were divided into 2 groups based on the median value of the TV-CAC score. The primary outcome was the stent expansion rate measured by IVUS after stent implantation. The secondary outcome was TLR within 1 year. ResultsStent expansion rate was associated with the TV-CAC score (p < 0.001). According to the ROC curve analysis, the TV-CAC score had the largest area under the curve (AUC) for the stent expansion area of 0.90 (AUC = 0.893, p < 0.001). The TV-CAC score was a positive predictor for stent expansion rate of <90% (odds ratio: 7.54, p < 0.001). Mediation analysis showed that stent under-expansion was a mediator of the association between high TV-CAC and TLR. ConclusionsOur study demonstrates that pre-intervention assessment of TV-CAC using MDCT is a predictor of stent expansion. The TV-CAC score might predict the complexity and help in the PCI operative strategy.

Impact of Intravascular Ultrasound on Chronic Total Occlusion Percutaneous Revascularization

AimWe sought to investigate the impact of IVUS use on chronic total occlusion (CTO) PCI using data from a contemporary registry of consecutive patients and applying a propensity score matching analysis. Methods and resultsWe evaluated 514 successful CTO-PCIs, median age: 67 years (IQR: 58–73), 83.5% males. IVUS-guided PCI was performed in 184 (35.8%) of cases. After using 1:1 propensity matching score analysis, two groups of 182 patients each (IVUS-guided vs. angiography-guided CTO-PCI group) were produced to form the study population.In the IVUS-guided group the median maximum stent diameter was larger and the median total stented segment was longer compared to the angiography-guided group [(3.5 mm, IQR: 3.0–4.0 vs. 3.2 mm, IQR: 3.0–3.5, p < 0.001) and (60.0 mm, IQR: 38.0–91.3 vs. 38.0 mm, IQR: 32.0–70.5, p < 0.001), respectively]. In the IVUS-guided group, retrograde recanalization was more frequently encountered compared to the angiography-guided PCI group (30.2% vs. 20.9%, p = 0.04). Procedural time was significantly longer in the IVUS-guided group, without any difference in fluoroscopy time, radiation dose and contrast volume. Multivariate linear regression analysis showed that IVUS use was the strongest independent factor associated with larger maximum diameter stents (p < 0.001) and a strong independent predictor for total stented segment length during CTO-PCI (p < 0.001).Up to 8 years follow-up, there was no difference in the incidence of the composite endpoint of all-cause death, cardiac death, myocardial infarction and target vessel revascularization between the IVUS-guided PCI and the angiography-guided PCI groups (hazard ratio: 13.7% vs. 15.9%, respectively, log-rank: p = 0.67, median follow-up time: 49.0 months, IQR: 33.0–67.0). ConclusionsUse of IVUS in CTO-PCI was associated with larger stent diameter and longer stented segments. Despite more frequent use of IVUS in retrograde CTO-PCI, there was no difference in long-term adverse events between IVUS and angiography CTO-PCI groups; nevertheless, the study was not powered to assess clinical outcomes.

Comparison between optical frequency domain imaging and intravascular ultrasound in PCI guidance for Biolimus A9 eluting stent implantation

Abstract Background It has been reported that intravascular ultrasound (IVUS) guided PCI reduced a risk of major adverse cardiac event compared to conventional angiography guided PCI, while comparison between IVUS-guided and optical frequency domain imaging (OFDI)-guided PCI specifically in long-term clinical outcomes (&amp;gt;1 year) has been unexplored. Purpose We sought to compare imaging surrogates at 8 months and clinical outcomes beyond 1 year after drug-eluting stent implantation between IVUS and OFDI guidance. Methods The MISTIC-1 is a prospective, multi-centre, single-blinded, randomised-controlled, non-inferiority trial comparing OFDI-guided and IVUS-guided PCI using Biolimus A9 eluting Nobori stent. We enrolled patients with stable coronary artery disease who have symptoms or clinically relevant myocardial ischemia. Stent landing zones were selected in the most normal looking sites with largest lumen and without percentage plaque area &amp;gt;50% in IVUS group while without lipidic plaque of &amp;gt;2 quadrants or suggestive thin-cap fibroatheroma in OFDI group. Stent sizing was based on external elastic lamina (EEL) in IVUS group, while by taking 10% or 0.25mm larger than mean lumen diameter at reference sites in OFDI group. Stent optimisation with in-stent minimum lumen area ≥80% of the average lumen area at proximal and distal reference sites was encouraged in both groups. Primary efficacy endpoint is in-segment minimum lumen area (MLA) assessed by OFDI at 8 months. Secondary safety endpoint is a composite of cardiovascular death, target vessel myocardial infarction, or target lesion revascularisation. Based on the assumption that mean in-segment MLA at follow-up was 4.5mm2 with a standard deviation of 2.0mm2 in the control (IVUS) group and a non-inferiority limit of 1.2mm2 for OFDI group, sample size was estimated as 48 cases in each group with 5% type I error and 90% statistical power. Results Since June-2014 and August-2016, we prospectively enrolled 109 patients (mean age 70 years, male 78%) with 126 lesions. Baseline patient and lesion characteristics were well balanced and average nominal size and length of stent used did not differ between OFDI-guided and IVUS-guided PCI (3.0 and 19.1mm vs. 3.1 and 19.3mm, respectively). Post-procedural minimum stent area was 6.24mm2 in OFDI group and 6.72mm2 in IVUS group (p=0.20). At 8-month follow-up, in-segment MLA was 4.56mm2 in OFDI group and 4.13mm2 in IVUS group (P for non-inferiority &amp;lt;0.001). During the follow-up (median 4.5 years [1654 days]), incidence rates of major adverse cardiac event were comparable between the two groups (7.4% in OFDI group and 7.3% in IVUS group, hazard ratio 0.96, 95% CI 0.24–3.83, p=0.95). No definite or probable stent thrombosis were documented in both groups. Conclusion OFDI-guided PCI demonstrated comparable results in achieving satisfactory imaging surrogates as well as long-term clinical outcomes after newer generation DES implantation as compared to IVUS-guided PCI. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Suzuken Memorial Foundation

Five-year major adverse cardiac and cerebrovascular events of patients with lipid core abutting lumen (LCAL) on integrated-backscatter intravascular ultrasound undergoing PCI with current DES

Abstract Background Percutaneous Coronary Intervention (PCI) using the new generation drug-eluting stent (DES) has been extremely reduced target lesion revascularization (TLR) in recent years. However, a high incidence of non-target lesion-related cardiovascular events in patients undergoing PCI is an important problem to be solved. According to the previous findings, patients with vulnerable plaques particularly have a high recurrence of cardiovascular events. Little studies, however, has been done to examine the relationship between plaque characteristics on intravascular imaging in a target lesion and non-target lesion-related cardiovascular events. Purpose The main objective of this study is to investigate the five-year major adverse cardiac and cerebrovascular events (MACCE) of patients with lipid core abutting lumen (LCAL) on integrated backscatter intravascular ultrasound (IB-IVUS) in a target lesion undergoing PCI with current DES. Methods and results Between February 2010 and September 2013, in total 780 patients with ischemic heart disease undergoing PCI, 166 target lesions in 166 consecutive patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) and stable angina pectoris (SAP) undergoing IVUS-guided PCI were studied. Plaque characteristics in all target lesions were analyzed by three-dimensional IB-IVUS system using the mechanical IVUS catheter. Our previous study has found that LCAL which is defined as a lipid pool directly in contact with the lumen visualizes the thin fibrous cap of less than 75μm on optical coherence tomography (OCT). On the basis of this data, LCAL at minimal lumen area (MLA) site was identified. In total, 39 patients had lesions with LCAL at MLA site (LCAL(+)), and 127 patients had those without LCAL (LCAL(−)). The primary endpoint was defined as MACCE, including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and non-TLR for the new lesion during a median follow up of five years. The MACCE occurred significantly higher in the LCAL(+) than in the LCAL(−) (38.5% vs. 17.3%; p&amp;lt;0.005). And the Kaplan-Meier estimates have shown that the cumulative incidence of MACCE was significantly higher in the LCAL(+) than in the LCAL(−) (log rank test, p=0.041). Additionally, after adjustment for confounders, gender, prior PCI and LCAL was the independent predictors for the MACCE of patients undergoing PCI with current DES. Furthermore, after adding LCAL to a baseline model with established factors consisting of age, gender, diabetes mellitus, prior PCI and percentage lipid volume on IB-IVUS, the net reclassification (p&amp;lt;0.002) and integrated discrimination improvement (p&amp;lt;0.004) significantly improved compared to baseline model alone. Conclusions In this study, it has become clear that LCAL on IB-IVUS is likely to be a surrogate marker of MACCE in patients undergoing PCI with current DES. Funding Acknowledgement Type of funding source: None

Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting.

This study sought to investigate the prognostic effect of a protocol with optimisation targets for intravascular ultrasound (IVUS)-guided left main (LM) revascularisation. A protocol was prospectively applied for IVUS-guided LM revascularisation (IVUS-PRO group) including predefined optimisation targets. Using propensity score matching, we selected as control groups patients with angiography-guided PCI (ANGIO group) and IVUS-guided PCI (IVUS group) from a large multicentre registry. The primary endpoint was a composite of cardiac death, LM-related infarction and LM revascularisation at 12 months. In each group, 124 patients with comparable characteristics were included. The incidence of the primary outcome was significantly higher in the ANGIO group compared to the IVUS-PRO group (12.9% vs 4.8%, HR 0.35, 95% CI: 0.15 to 0.82, p=0.02), but not with respect to the IVUS group (12.9% vs 8%, HR 0.51, 95% CI: 0.20 to 1.22, p=0.1), driven by a lower rate of LM revascularisation (8% in the ANGIO group, 6.4% in the IVUS group and 3.2% in the IVUS-PRO group). IVUS-PRO resulted in being an independent risk predictor (HR 0.45, 95% CI: 0.15 to 0.98; p=0.041). IVUS guidance of LM stenting provides prognostic benefit with respect to the use of angiography alone, particularly when following a protocol with these predefined optimisation criteria.

In-Hospital and 1-Year Results of Intravascular Ultrasound-Guided Versus Angiography-Guided Intervention for Type C Coronary Lesions

Background: Class C lesions are considered to have the highest degree of lesion complexity so we compared between Intravascular Ultrasound (IVUS)-guided and angiography-guided PCI for Type C coronary lesions regarding procedural success and occurrence of Major Adverse Cardiac Events (MACE). Results: Our study was conducted on patients undergoing elective PCI for type C coronary lesions. The study included 50 patients who underwent IVUS guided PCI and 50 patients who underwent angiographic guided PCI. We evaluated IVUS guidance on clinical outcomes. MACE, all-cause mortality, ST elevation infarction, and target lesion revascularization, were end points for comparison. Follow-up duration was 12 months. Adding IVUS to the procedure was associated with more procedure time but with less amount of contrast. Patients with IVUS-guided PCI underwent more direct stenting, post-dilatation, larger maximal stent diameter, and greater number of implanted stents. The IVUS guided group had significantly better final diameter stenosis but at 1-year follow up, IVUS use failed to reduce MACE significantly in comparison to angiographic guidance. In conclusion: use of IVUS is associated with lower amount of radiographic contrast used during the procedure, more procedural time, more post dilatation and less postintervention final diameter stenosis. In addition, use of IVUS in complex lesions allows optimizing PCI procedures and stent apposition. A strategy of IVUS for stent implantation in complex coronary lesions didn’t reduce the 1-year MACE rates and thus, isn’t recommended routinely

3285Impact of intravascular ultrasound-guided percutaneous coronary intervention in patients with diabetes mellitus and chronic kidney disease

Abstract Background Several studies have shown favorable results using IVUS-guided PCI. Nevertheless, patient background in which use of IVUS is effective is not well elucidated. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) tend to have complex coronary artery lesions. We sought to assess the impact of IVUS guidance on clinical outcomes in these patients. Methods Kumamoto Intervention Conference Study is a multicenter registry which has enrolled consecutive patients who underwent PCI in 16 centers in Japan. Between August 2008 and March 2014, 11,195 consecutive patients were enrolled in this registry. To elucidate the efficacy of IVUS usage in DM and CKD patients, 10,822 consecutive subjects with 1-year follow-up data were analyzed. In this patient population, 69.2% (n=7,493) of patients were treated with IVUS-guided PCI. Patients were divided into 4 groups: the No Risk Group, the DM only Group, the CKD only Group, and the DM+CKD Group. Results Maximum stent diameter, post dilatation rate, usage of distal protection device, and rotational atherectomy rate were significantly higher in the IVUS-guided PCI patients in all 4 groups. 1-year MACE (cardiovascular death, non-fatal myocardial infarction, and MI with stent thrombosis) was significantly lower in the IVUS-guided PCI patients than angiography-guided PCI patients in each subset, except for the No Risk Group. In contrast to angiography-guided PCI patients, there were no significant differences among the 4 groups as regards 1-year MACE in the IVUS-guided PCI patients except for the DM+CKD Group. In multiple regression analysis, IVUS usage was an independent negative predictor for 1-year MACE in the DM only Group (HR=0.374, 95% CI 0.194–0.719, p=0.003) and in the CKD only Group (HR=0.604, 95% CI 0.379–0.962, p=0.010). When the No Risk Group was used as a reference, the HR has increased according to increased risk factors in the angiography-guided PCI patients, but such tendency was not necessarily observed in the IVUS-guided PCI patients (Table). Risk Stratification of DM and CKD Variable IVUS-Guided PCI Angiography-Guided PCI HR 95% CI P HR 95% CI P The No Risk Group Reference – – Reference – – vs. the DM only Group 0.627 0.321–1.227 0.173 2.036 1.090–3.804 0.026 vs. the CKD only Group 1.334 0.795–2.237 0.275 2.730 1.541–4.836 0.001 vs. the DM+CKD Group 2.114 1.287–3.474 0.014 2.225 1.160–4.266 0.016 Conclusion The efficacy of IVUS usage as regards 1-year MACE was confirmed in DM and CKD patients, but not observed in patients without them or in the combination of DM and CKD patients. Acknowledgement/Funding None

Value of intravascular ultrasound in guiding coronary interventions.

There has been great effort to improve clinical outcome in percutaneous treatment for coronary artery disease. Complementary to coronary angiography, intravascular ultrasound (IVUS) provides in vivo tomographic anatomic information, enabling to evaluate from the lumen to the vessel wall. As a result, IVUS has had a pivotal role to understand pathophysiology of coronary artery disease and improve clinical outcome. It provides preprocedural information to evaluate stenosis severity and plaque characteristics and helps with optimal stent deployment, minimizing underexpansion and geographic miss that are the major mechanisms of stent failure. Recently, many large-scale clinical trials and meta-analyses with drug-eluting stents have shown the clinical benefits of IVUS-guided percutaneous coronary intervention. Some recent studies have also supported the cost-effectiveness of IVUS-guided PCI especially in high-risk patients. This article will discuss the clinical value of IVUS in contemporary practice.

The role of modern methods for&#x0D; intravascular visualization of coronary arteries in diagnostics and treatment of coronary heart disease in the employees of the Russian&#x0D; Railways joint stock company related to train movements.

The aim of this study was to show the importance of modern non X-ray diagnostic techniques of coronary arteries for diagnosis and treatment of CHD. Material and methods. 110 patients, who took part in the study, were divided into two groups according to their coronarography: group 1 - patients with intermediate coronary stenosis (n = 80) and group 2 - patients with normal coronary arteries (n = 30). All patients of group1 underwent FFR measurement in the magistral arteries. On the base of FFR value the second group was conventionally divided into two subgroups: Ia (47.5% patients) - with a positive FFR value (≤0,8), in which the lesion was considered functionally significant and responsible for ischemia, and Ib (52.5% patients) - with a negative FFR value (&gt;0,8). In the case of positive FFR value patients underwent IVUS-guided PCI. Results. Survival index free of MACE and readmissions was not significantly different in the group II and subgroup Ib and were 100 and 95.2%, respectively (p &gt; 0.05). A comparison of this index in the subgroups Ia and Ib was no significantly different (97.3% and 95.2%, respectively, p &gt; 0.05). The rate of restenosis in the Ia subgroup, which required re-intervention, was 2.7%, which corresponds to the data in the literature. Late stent thrombosis was not revealed. Conclusions. Survival index free of MACE and readmissions is not different in the long-term period in the study groups.

Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention with drug-eluting stents: five-year outcomes from the CREDO-Kyoto PCI/CABG registry.

We sought to investigate the clinical impact of intravascular ultrasound (IVUS) use in first-generation drug-eluting stent (DES) implantation as compared with angiography guidance only. From the CREDO-Kyoto registry cohort-2, the current study population consisted of 4,768 patients treated with first-generation DES only without acute myocardial infarction (AMI) at enrolment. As a retrospective cohort study, we compared clinical outcomes between the two groups of patients with or without IVUS use during the procedure (IVUS group: N=2,768, angiography group: N=2,000). The outcome measures were target vessel revascularisation (TVR), target lesion revascularisation (TLR), all-cause death, myocardial infarction, stent thrombosis, and major adverse cardiovascular events. There was no significant difference between the groups in the cumulative incidence of TVR (21.5% vs. 22.2%, p=0.57). Even after adjusting the confounders, the risk of IVUS use relative to angiography guidance for TVR remained neutral (HR: 1.09, 95% CI: 0.90-1.32, p=0.37). IVUS-guided PCI as compared with angiography-guided PCI was not associated with a lower risk of TVR in non-AMI patients treated with first-generation DES.