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Hamed M, Mohamed S, Mahmoud M, Kahan J, Mohsen A, Rahman F, Kayani W, Alfonso F, Brilakis ES, Elgendy IY, Mamas MA, Elbadawi A. Intravascular Imaging-Guided Versus Coronary Angiography-Guided Complex PCI: A Meta-analysis of Randomized Controlled Trials. Cardiol Ther 2024; 13:379-399. [PMID: 38630393 PMCID: PMC11093926 DOI: 10.1007/s40119-024-00364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/04/2024] [Indexed: 05/15/2024] Open
Abstract
INTRODUCTION Trials evaluating the role of intravascular imaging in percutaneous coronary intervention (PCI) for complex coronary artery disease have yielded mixed results. This study aimed to compare the outcomes of intravascular imaging specifically intravascular ultrasound (IVUS) with those from conventional coronary angiography in complex PCI. METHODS Comprehensive electronic search of MEDLINE, EMBASE, and Cochrane databases was performed until March 2023 for randomized clinical trials (RCTs) comparing intravascular imaging with coronary angiography in patients undergoing complex PCI. Complex PCI was defined per each study, and included PCI for American College of Cardiology/American Heart Association (ACC/AHA) type B2/C lesions, unprotected left main coronary artery disease, or multivessel stenting. The primary study outcome was major adverse clinical events (MACE). RESULTS The meta-analysis included 10 RCTs with a total of 6615 patients (3576 in the intravascular imaging group and 3039 in the coronary angiography group). The weighted mean-follow up was 28.9 months. Compared with coronary angiography, intravascular imaging reduced MACE (8% vs. 13.3%; relative risk [RR] 0.63; 95% confidence interval [CI] 0.54-0.73), cardiac death (RR 0.47; 95% CI 0.31-0.73), definite/probable stent thrombosis (RR 0.48; 95% CI 0.24-0.97), target vessel revascularization (RR 0.62; 95% CI 0.46-0.83), and target lesion revascularization (RR 0.61; 95% CI 0.47-0.79). There was no difference between both groups in all-cause death (RR 0.79; 95% CI 0.53-1.18) and myocardial infarction (RR 0.80; 95% CI 0.61-1.04). CONCLUSION In patients undergoing complex PCI, intravascular imaging-specifically IVUS-reduced MACE by decreasing the incidence of cardiac death, stent thrombosis, and target vessel and target lesion revascularization.
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Affiliation(s)
- Mohamed Hamed
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheref Mohamed
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Mohamed Mahmoud
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan Kahan
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University, Loma Linda, CA, USA
| | - Faisal Rahman
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Waleed Kayani
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | | | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Ayman Elbadawi
- Division of Cardiology, Christus Good Shepherd Medical Center, Longview, TX, USA.
- Texas A&M School of Medicine, Bryan, TX, USA.
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Vergallo R, Patrono C. Weekly journal scan: intravascular imaging to guide percutaneous coronary intervention-ready for prime time? Eur Heart J 2024:ehae242. [PMID: 38703139 DOI: 10.1093/eurheartj/ehae242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, Genova 16132, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 6, Genova 16132, Italy
| | - Carlo Patrono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Rome, Italy
- Center of Excellence on Ageing, CAST, 'G. d'Annunzio' University School of Medicine, Chieti, Italy
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Stone GW, Christiansen EH, Ali ZA, Andreasen LN, Maehara A, Ahmad Y, Landmesser U, Holm NR. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. Lancet 2024; 403:824-837. [PMID: 38401549 DOI: 10.1016/s0140-6736(23)02454-6] [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] [Received: 09/01/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Previous meta-analyses have shown reduced risks of composite adverse events with intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography guidance alone. However, these studies have been insufficiently powered to show whether all-cause death or all myocardial infarction are reduced with intravascular imaging guidance, and most previous intravascular imaging studies were done with intravascular ultrasound rather than optical coherence tomography (OCT), a newer imaging modality. We aimed to assess the comparative performance of intravascular imaging-guided PCI and angiography-guided PCI with drug-eluting stents. METHODS For this systematic review and updated meta-analysis, we searched the MEDLINE, Embase, and Cochrane databases from inception to Aug 30, 2023, for studies that randomly assigned patients undergoing PCI with drug-eluting stents either to intravascular ultrasound or OCT, or both, or to angiography alone to guide the intervention. The searches were done and study-level data were extracted independently by two investigators. The primary endpoint was target lesion failure, defined as the composite of cardiac death, target vessel-myocardial infarction (TV-MI), or target lesion revascularisation, assessed in patients randomly assigned to intravascular imaging guidance (intravascular ultrasound or OCT) versus angiography guidance. We did a standard frequentist meta-analysis to generate direct data, and a network meta-analysis to generate indirect data and overall treatment effects. Outcomes were expressed as relative risks (RRs) with 95% CIs at the longest reported follow-up duration. This study was registered with the international prospective register of systematic reviews (PROSPERO, number CRD42023455662). FINDINGS 22 trials were identified in which 15 964 patients were randomised and followed for a weighted mean duration of 24·7 months (longest duration of follow-up in each study ranging from 6 to 60 months). Compared with angiography-guided PCI, intravascular imaging-guided PCI resulted in a decreased risk of target lesion failure (RR 0·71 [95% CI 0·63-0·80]; p<0·0001), driven by reductions in the risks of cardiac death (RR 0·55 [95% CI 0·41-0·75]; p=0·0001), TV-MI (RR 0·82 [95% CI 0·68-0·98]; p=0·030), and target lesion revascularisation (RR 0·72 [95% CI 0·60-0·86]; p=0·0002). Intravascular imaging guidance also reduced the risks of stent thrombosis (RR 0·52 [95% CI 0·34-0·81]; p=0·0036), all myocardial infarction (RR 0·83 [95% CI 0·71-0·99]; p=0·033), and all-cause death (RR 0·75 [95% CI 0·60-0·93]; p=0·0091). Outcomes were similar for OCT-guided and intravascular ultrasound-guided PCI. INTERPRETATION Compared with angiography guidance, intravascular imaging guidance of coronary stent implantation with OCT or intravascular ultrasound enhances both the safety and effectiveness of PCI, reducing the risks of death, myocardial infarction, repeat revascularisation, and stent thrombosis. FUNDING Abbott.
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Affiliation(s)
- Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA; Columbia University Medical Center, New York, NY, USA
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ulf Landmesser
- Deutsches Herzzentrum Charité, Charité Universitätsmedizin Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
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Toth GG, Kandzari DE, Kirtane AJ, Windecker S, Latib A, Kedhi E, Mehran R, Price MJ, Choi JW, Caputo R, Troquay R, Diderholm E, Singh S, Brar SS, Loussararian A, Chetcuti S, Tulli M, Stone GW, Lung TH, Mylotte D. Two-year results from Onyx ONE clear in patients with high bleeding risk on one-month DAPT with and without intracoronary imaging. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:60-67. [PMID: 37550123 DOI: 10.1016/j.carrev.2023.07.016] [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: 02/22/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Patients with high bleeding risk (HBR) are often treated with abbreviated dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) to reduce bleeding risk, however this strategy is associated with an increase in ischemic events, especially if the acute PCI result is suboptimal. We compared clinical outcomes among patients with HBR treated with 1-month DAPT who underwent intravascular ultrasound (IVUS)- or optical coherence tomography (OCT)-guided PCI versus those who underwent angiography-guided PCI without intravascular imaging. METHODS The Onyx ONE Clear study includes patients with HBR from the Onyx ONE US/Japan and Onyx ONE randomized studies who were treated with the Resolute Onyx zotarolimus-eluting stent. The primary endpoint was the composite of cardiac death (CD) or myocardial infarction (MI) between 1 month and 2 years after PCI. Propensity-score adjustments and matching were performed for differences in baseline and procedural characteristics between groups. RESULTS Among the 1507 patients in Onyx ONE Clear, 271 (18.0 %) had IVUS or OCT used during PCI (Imaging-guided group) and 1236 (82.0 %) underwent Angiography-guided PCI (Angio-guided group). Imaging-guided patients were less likely to present with atrial fibrillation, acute coronary syndrome, and left ventricle ejection fraction ≤35 %. Conversely, Imaging-guided patients were more likely to have complex (ACC/AHA type B2/C), longer, and heavily calcified lesions. Between 1 month and 2 years, the composite rate of CD or MI was similar between Imaging-guided and Angio-guided patients (9.9 % vs. 12.4 %, P = 0.33). There was also no difference between groups after adjustment; (P = 0.56). However, CD was significantly lower among Imaging-guided patients (2.7 % vs. 6.1 %, P = 0.048). There were no between-group differences in MI or stent thrombosis. Propensity score matching results were similar. CONCLUSION Despite higher lesion complexity, using intravascular imaging guidance for PCI between 1-month and 2-years follow-up had comparable outcomes with angiographic guidance alone in patients with HBR treated with 1-month DAPT. (ClinicalTrials.gov: Identifier: NCT03647475 and NCT03344653). NON-STANDARD ABBREVIATIONS AND ACRONYMS BARC: Bleeding Academic Research Consortium; DAPT: dual antiplatelet therapy; DES: drug-eluting stent; HBR: high bleeding risk; IVUS: intravascular ultrasound; OCT: optical coherence tomography; SAPT: single antiplatelet therapy.
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Affiliation(s)
- Gabor G Toth
- University Heart Center Graz, Medical University Graz, Graz, Austria
| | | | - Ajay J Kirtane
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, United States of America; The Cardiovascular Research Foundation, New York, NY, United States of America
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, United States of America
| | - Elvin Kedhi
- Free University of Brussels, Brussels, Belgium
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - James W Choi
- Baylor Heart & Vascular Hospital, Dallas, TX, United States of America
| | - Ronald Caputo
- Saint Joseph's Hospital Heart Center, Syracuse, NY, United States of America
| | | | | | - Sunil Singh
- Memorial Hospital of Jacksonville, Jacksonville, FL, United States of America
| | - Somjot S Brar
- Kaiser Permanente Los Angeles, Los Angeles, CA, United States of America
| | - Arthur Loussararian
- Providence Mission Hospital Regional Medical Center, Mission Viejo, CA, United States of America
| | - Stanley Chetcuti
- University of Michigan Health Center, University Hospital, Ann Arbor, MI, United States of America
| | - Mark Tulli
- North Florida Regional Medical Center, Gainesville, FL, United States of America
| | - Gregg W Stone
- The Cardiovascular Research Foundation, New York, NY, United States of America; The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, United States of America
| | - Te-Hsin Lung
- Medtronic, Santa Rosa, CA, United States of America
| | - Darren Mylotte
- University Hospital and National University of Ireland Galway, Galway, Ireland.
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Machanahalli Balakrishna A, Ismayl M, Goldsweig AM, Peters LA, Alla VM, Velagapudi P, Zhao DX, Vallabhajosyula S. Intracoronary Imaging Versus Coronary Angiography Guidance for Implantation of Second and Third Generation Drug Eluting Stents in a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 202:100-110. [PMID: 37423173 DOI: 10.1016/j.amjcard.2023.06.073] [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] [Received: 01/10/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
Intracoronary imaging (ICI) facilitates stent implant by characterizing the lesion calcification, providing accurate vessel dimensions, and optimizing the stent results. We sought to investigate the outcomes of routine ICI versus coronary angiography (CA) to guide percutaneous coronary intervention (PCI) with second- and third-generation drug-eluting stents. A systematic search of PubMed, Medline, and Cochrane databases was conducted from their inception to July 16, 2022 for randomized controlled trials comparing routine ICI with CA. The primary outcome was major adverse cardiovascular events. The secondary outcomes of interest were target lesion revascularization, target vessel revascularization, myocardial infarction, stent thrombosis, and cardiac and all-cause mortality. A random-effects model was used to calculate the pooled incidence and relative risk (RR) with 95% confidence intervals (CIs). A total of 9 randomized controlled trials with 5,879 patients (2,870 ICI-guided and 3,009 CA-guided PCI) met the inclusion criteria. The ICI and CA groups were similar in demographic characteristics and co-morbidity profiles. Compared with CA, patients in the routine ICI-guided PCI group had lower rates of major adverse cardiovascular events (RR 0.61, 95% CI 0.48 to 0.78, p <0.0001), target lesion revascularization (RR 0.60, 95% CI 0.43 to 0.83, p = 0.002), target vessel revascularization (RR 0.72, 95% CI 0.51 to 1.00, p = 0.05), and myocardial infarction (RR 0.48, 95% CI 0.25 to 0.95, p = 0.03). There were no significant differences in stent thrombosis or cardiac/all-cause mortality between the 2 strategies. In conclusion, routine ICI-guided PCI strategy, compared with CA guidance alone, is associated with improved clinical outcomes, largely driven by lower repeat revascularization.
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Affiliation(s)
| | - Mahmoud Ismayl
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, Department of Medicine, University of Nebraska School of Medicine, Omaha, Nebraska
| | - Luke A Peters
- Section of Cardiovascular Medicine, Department of Medicine and
| | - Venkata M Alla
- Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Poonam Velagapudi
- Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine and
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine and; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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Wu X, Wu M, Huang H, Liu Z, Cai J, Zhang Q, Huang H. Antegrade versus Retrograde Approach for Recanalization of Ostial or Stumpless Coronary Chronic Total Occlusion. Int J Gen Med 2023; 16:3995-4005. [PMID: 37674582 PMCID: PMC10479831 DOI: 10.2147/ijgm.s429956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose This research aimed to evaluate the procedural and in-hospital clinical outcomes of percutaneous coronary intervention (PCI) for ostial or stumpless chronic total occlusion (CTO) utilizing both the antegrade-only and retrograde approaches. Methods A comprehensive retrospective examination was conducted on the procedural and in-hospital clinical outcomes of 89 consecutive patients subjected to ostial or stumpless CTO PCI at our institution between April 2015 and October 2022. Results The antegrade-only technique demonstrated a superior technical success rate (92.0% vs 71.9%, p = 0.041) and procedural success rate (92.0% vs 68.8%, p = 0.022) in comparison to the retrograde approach (RA). The RA group presented a notably elevated Japanese-CTO (J-CTO) score relative to the antegrade-only approach group (2.45±0.73 vs 1.64±0.70, p < 0.001). The antegrade-only approach group manifested an increased frequency of microchannels at the proximal stump relative to the RA group (56.0% vs 10.9%, p < 0.001). In-hospital major adverse cardiac events (MACE) and in-hospital myocardial infarction (MI) were observed more prevalently in the RA group (18.8% vs 0, p = 0.003; 15.6% vs 0, p = 0.008; respectively). A J-CTO score below 2 and the manifestation of microchannels at the proximal stump were identified as predictors for successful antegrade-only approach PCI for ostial or stumpless CTO (OR: 2.79 [95% CI: 1.92-5.03, P =0.003]; OR: 2.89 [95% CI: 1.32-6.03, P =0.001]; respectively). Conclusion Relative to RA PCI for ostial or stumpless CTO, the antegrade-only approach is utilized for less complex CTO lesions and is associated with a diminished probability of in-hospital MACE.
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Affiliation(s)
- Xi Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Zhe Liu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Jie Cai
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Qizhou Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - He Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
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Escaned J, Berry C, De Bruyne B, Shabbir A, Collet C, Lee JM, Appelman Y, Barbato E, Biscaglia S, Buszman PP, Campo G, Chieffo A, Colleran R, Collison D, Davies J, Giacoppo D, Holm NR, Jeremias A, Paradies V, Piróth Z, Raposo L, Roguin A, Rudolph T, Sarno G, Sen S, Toth GG, Van Belle E, Zimmermann FM, Dudek D, Stefanini G, Tarantini G. Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology. EUROINTERVENTION 2023; 19:464-481. [PMID: 37171503 PMCID: PMC10436072 DOI: 10.4244/eij-d-23-00194] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.
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Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Asad Shabbir
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yolande Appelman
- Amsterdam UMC, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Piotr P Buszman
- Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- American Heart of Poland, Ustroń, Poland
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Róisín Colleran
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Justin Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Daniele Giacoppo
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
- ISAResearch, German Heart Centre Munich, Munich, Germany
| | - Niels R. Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Luís Raposo
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Giovanna Sarno
- Cardiology, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gabor G Toth
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Lille, France
- Department of Cardiology, Institut Pasteur de Lille, Lille, France
| | | | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- University of Padua Medical School, Padua, Italy
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8
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Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: Evidence and Clinical Trials. Interv Cardiol Clin 2023; 12:177-185. [PMID: 36922059 DOI: 10.1016/j.iccl.2022.10.004] [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: 02/03/2023]
Abstract
The intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) that was associated with improved post-procedural outcomes and long-term clinical outcomes has shown benefits not only in patients with complex lesions but also with simplex lesions. However, the use of IVUS during PCI remains low; therefore, further prospective, randomized, controlled trials are required to strengthen the recommendations and consequently expand its usage. The aim of this review is to discuss the previous evidences and clinical trials regarding IVUS-guided PCI and to discover the necessity for future studies to broaden its use in the real-world clinical practice.
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Suwannasom P, Chichareon P, Roongsangmanoon W, Thongtanomkul A, Wongpen A, Muenkaew M, Kanoksilp A, Chandavimol M, Kuanprasert S, Thakkinstian A, Srimahachota S, Sansanayudh N. Impact of the adjunctive use criteria for intravascular ultrasound-guided percutaneous coronary intervention and clinical outcomes. Sci Rep 2023; 13:711. [PMID: 36639405 PMCID: PMC9839682 DOI: 10.1038/s41598-022-27250-3] [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] [Received: 10/11/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
The impact of the adherence to the adjunctive use criteria (AUC) for intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) and clinical outcomes in low IVUS volume countries are limited. The current study compared the procedural success and complication rates between used and not used IVUS catheter in the patients who were met (C +) and were not met (C-) the AUC for IVUS-guided PCI. From June 2018 through June 2019, a total of 21,066 patients were included in the Thai PCI registry. Among the study population, 15,966 patients (75.8%) have met the IVUS-AUC. The IVUS-guided PCI rates were 14.5% and 11.3% in the C + and C - groups, respectively. After adjusting for covariables by propensity model, IVUS-guided PCI was identified as an independent predictor of the procedural success rate regardless of whether the AUC were met with the relative risk [RR (95% confidence interval (CI)] of 1.033(1.026-1.040) and 1.012(1.002-1.021) in C + and C- groups, respectively. IVUS-guided PCI increased the procedural complication risks in both groups but were not significant with corresponding RRs of 1.171(0.915-1.426) and 1.693(0.959-2.426). Procedural success was achieved with IVUS-guided PCI regardless of whether the AUC were met. IVUS-guided PCI did not lead to an increase in procedural complications.
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Affiliation(s)
- Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ply Chichareon
- Faculty of Medicine, Songklanakarind Hospital, Prince of Songkla University, Songkla, Thailand
| | - Worawut Roongsangmanoon
- Faculty of Medicine, HRH Princess MahaChakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand
| | | | | | - Muenpetch Muenkaew
- Faculty of Medicine, Thammasat University Hospital, Thammasat University, Bangkok, Thailand
| | - Anek Kanoksilp
- Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Mann Chandavimol
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Srun Kuanprasert
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Srimahachota
- Division of Cardiovascular Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nakarin Sansanayudh
- Phramongkutklao College of Medicine, 315 Ratchawithi Rd, Khwaeng Thung Phaya Thai, Bangkok, 10400, Thailand.
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10
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Pushparaji B, Donisan T, Balanescu DV, Park JK, Monlezun DJ, Ali A, Inanc IH, Caballero J, Cilingiroglu M, Marmagkiolis K, Iliescu C. Coronary Revascularization in Patients With Cancer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2023; 25:143-158. [PMID: 37143711 PMCID: PMC10119009 DOI: 10.1007/s11936-023-00982-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
Purpose of review The treatment of coronary artery disease (CAD) in cancer patients is an evolving landscape. Recent data emphasizes the importance of aggressive management of cardiovascular risk factors and diseases in improving cardiovascular health in this unique group of patients regardless of cancer type or stage. Recent findings Novel cancer therapeutics such as immune therapies and proteasome inhibitors have been associated with CAD. Recent stent technologies may safely allow for shorter duration (< 6 months) of dual antiplatelet therapy post-percutaneous coronary interventions. Intracoronary imaging may be useful in the decision making process in terms of stent positioning and healing. Summary Large registry studies have partially filled a gap left by the lack of randomized controlled trials in the treatment of CAD in cancer patients. Cardio-oncology is gaining traction as a major sub-specialty in the cardiology field given the release of the first European Society of Cardiology - Cardio-oncology guidelines in 2022.
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Affiliation(s)
- Bala Pushparaji
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY USA
| | - Teodora Donisan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | | | - Jong Kun Park
- Deparment of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Dominique J. Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Abdelrahman Ali
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Research and Training Hospital, Kirikkale, Turkey
| | - Jaime Caballero
- Interventional Cardiology, Department of Internal Medicine, University of South Florida, Tampa, FL USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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11
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Elzeneini M, Betageri O, Kamisetty SR, Assaf Y, Elgendy IY, Shah KB. Utilization Rate and Outcomes of Intravascular Imaging in Elderly Patients Presenting With ST-Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:90-95. [PMID: 35970702 DOI: 10.1016/j.carrev.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Elderly patients presenting with ST-elevation myocardial infarction (STEMI) represent a vulnerable population with comorbid conditions and complex coronary anatomy. We aimed to describe the utilization rate and outcomes of intravascular imaging to guide percutaneous coronary intervention (PCI) in this population. METHODS The Nationwide Readmissions Database was queried for all hospitalizations for STEMI involving PCI from 2018 to 2019. Hospitalizations were stratified by patient age into a younger cohort <75 years (mean age 58.7 ± 9.5 years) and an older cohort ≥75 years. Propensity score-weighed regression analysis was used to identify the association of intravascular imaging with in-hospital mortality, 90-day all-cause readmission, and readmission for myocardial infarction (MI). RESULTS A total of 299,619 STEMI PCI hospitalizations were included. Intravascular imaging was utilized less frequently in the older cohort (6.8 % vs 7.8 %, odds ratio [OR] 0.87, 95 % CI 0.82-0.92, p < 0.001). In both cohorts, intravascular imaging was more likely to be used with anterior STEMI, complex PCI, mechanical support, and thrombectomy. Propensity score analysis showed the use of intravascular imaging was associated with lower in-hospital mortality in both cohorts (OR 0.60, 95 % CI 0.52-0.68, p < 0.001 in the younger cohort and OR 0.61, 95 % CI 0.51-0.72, p < 0.001 in the older cohort). There was no difference in 90-day all-cause readmission or readmission for MI with intravascular imaging. CONCLUSIONS Intravascular imaging during STEMI PCI is associated with lower in-hospital mortality regardless of age. Further studies are needed to understand the low utilization rates especially among elderly patients.
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Affiliation(s)
- Mohammed Elzeneini
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Omkar Betageri
- Division of Cardiovascular Medicine, Maine Medical Center, Portland, ME, United States of America
| | - Sujay R Kamisetty
- Department of Internal Medicine, University of Florida, Gainesville, FL, United States of America
| | - Yazan Assaf
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, United States of America
| | - Khanjan B Shah
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
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12
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Niu Y, Bai N, Ma Y, Zhong PY, Shang YS, Wang ZL. Efficacy of intravascular imaging-guided drug-eluting stent implantation: a systematic review and meta-analysis of randomized clinical trials. BMC Cardiovasc Disord 2022; 22:327. [PMID: 35870904 PMCID: PMC9308935 DOI: 10.1186/s12872-022-02772-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traditional angiography only displays two-dimensional images of the coronary arteries during stent implantation. However, intravascular imaging can show the structure of the vascular wall, plaque characteristics. This article aims to evaluate the efficacy of intravascular imaging-guided drug-eluting stent (DES) implantation.
Method
We conducted a systematic review and meta-analysis of randomized controlled trials of intravascular imaging-guided, including patients with DES implantation guided by intravascular ultrasound or optical coherence tomography and traditional angiography. The databases of PubMed, EMBASE, web of science, and Cochrane Library were searched. The primary outcome was target lesion revascularization (TLR). The secondary outcomes included the target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), cardiac death, all-cause death, and the major adverse cardiac events (MACE) during the 6–24 months follow-up. The fixed-effects model was used to calculate the relative risk (RR) and 95% confidence interval of the outcome event. Meanwhile, the trial sequence analysis was employed to evaluate the results.
Result
This meta-analysis included fourteen randomized controlled trials with 7307 patients. Compared with angiography-guided, intravascular imaging-guided DES implantation can significantly reduce the risk of TLR (RR 0.63, 0.49–0.82, P = 0.0004), TVR (RR 0.66, 0.52–0.85, P = 0.001), cardiac death (RR 0.58; 0.38–0.89; P = 0.01), MACE (RR 0.67, 0.57–0.79; P < 0.00001) and ST (RR 0.43, 0.24–0.78; P = 0.005). While there was no significant difference regarding MI (RR 0.77, 0.57–1.05, P = 0.10) and all-cause death (RR 0.87, 0.58–1.30, P = 0.50).
Conclusions
Compared with angiography, intravascular imaging-guided DES implantation is associated with better clinical outcomes in patients with coronary artery disease, especially complex lesions (Registered by PROSPERO, CRD 42021289205).
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13
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Rangé G, Hakim R. [Penetration of endocoronary imaging in France (data from France PCI): The French exception]. Ann Cardiol Angeiol (Paris) 2022; 71:350-355. [PMID: 36272832 DOI: 10.1016/j.ancard.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Evaluate intravascular coronary imaging (ICI) utilization in France and compare it with other countries. METHODOLOGY We included in our study all PCI performed between 2014 and 2021 in all participating centers of France PCI registry. RESULTS The percentage of ICI use during PCI varied from 1.2% to 1% between 2014 and 2020 in the France PCI Registry. In 2021, among 45,227 PCI procedures performed at the 41 participating centers, 768 (1.7%) had an ICI, including 329 (0.7%) with OCT, 341 (0.8%) with IVUS, and 98 (0.2%) undetermined. In "all-comers" PCI, the rate of ICI use was 1.7% in France, 2.5% in the United States, 10% in Sweden, 16.2% in the United Kingdom, and 84.4% in Japan. In left main PCI, the rate was 5.8% in France, 62.3% in Sweden, 66.6% in the UK, and 96.6% in Japan. In the France PCI registry, the rate of ICI use ranged from 0% to 9.5% in all PCI and from 0% to 30% in left main PCI. CONCLUSION ICI techniques are exceptionally used in France in routine practice, in contrast to our European neighbors such as Swede or the United Kingdom. Obtaining reimbursement in certain recommended indications and participation in a national interventional cardiology registry with incentive practice indicators should improve this situation.
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Affiliation(s)
| | - Radwan Hakim
- Hôpitaux de Chartres, Service de Cardiologie, France
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14
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Ahmed T, Pacha HM, Addoumieh A, Koutroumpakis E, Song J, Charitakis K, Boudoulas KD, Cilingiroglu M, Marmagkiolis K, Grines C, Iliescu CA. Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents. Front Cardiovasc Med 2022; 9:901431. [DOI: 10.3389/fcvm.2022.901431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundManagement of coronary artery disease (CAD) is unique and challenging in cancer patients. However, little is known about the outcomes of using BMS or DES in these patients. This study aimed to compare the outcomes of percutaneous coronary intervention (PCI) in cancer patients who were treated with bare metal stents (BMS) vs. drug-eluting stents (DES).MethodsWe identified cancer patients who underwent PCI using BMS or DES between 2013 and 2020. Outcomes of interest were overall survival (OS) and the number of revascularizations. The Kaplan–Meier method was used to estimate the survival probability. Multivariate Cox regression models were utilized to compare OS between BMS and DES.ResultsWe included 346 cancer patients who underwent PCI with a median follow-up of 34.1 months (95% CI, 28.4–38.7). Among these, 42 patients were treated with BMS (12.1%) and 304 with DES (87.9%). Age and gender were similar between the BMS and DES groups (p = 0.09 and 0.93, respectively). DES use was more frequent in the white race, while black patients had more BMS (p = 0.03). The use of DES was more common in patients with NSTEMI (p = 0.03). The median survival was 46 months (95% CI, 34–66). There was no significant difference in the number of revascularizations between the BMS and DES groups (p = 0.43). There was no significant difference in OS between the BMS and DES groups in multivariate analysis (p = 0.26). In addition, independent predictors for worse survival included age > 65 years, BMI ≤ 25 g/m2, hemoglobin level ≤ 12 g/dL, and initial presentation with NSTEMI.ConclusionsIn our study, several revascularizations and survival were similar between cancer patients with CAD treated with BMS and DES. This finding suggests that DES use is not associated with an increased risk for stent thrombosis, and as cancer survival improves, there may be a more significant role for DES.
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15
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Madder RD, Seth M, Sukul D, Alraies MC, Qureshi M, Tucciarone M, Saltiel F, Qureshi MI, Gurm HS. Rates of Intracoronary Imaging Optimization in Contemporary Percutaneous Coronary Intervention: A Report From the BMC2 Registry. Circ Cardiovasc Interv 2022; 15:e012182. [PMID: 36256694 DOI: 10.1161/circinterventions.122.012182] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intracoronary imaging (ICI) during percutaneous coronary intervention (PCI) improves outcomes, yet hospital- and physician-level variabilities in ICI and its impact on ICI use in contemporary PCI remain unknown. This study was performed to evaluate hospital- and physician-level use of ICI to optimize PCI. METHODS Using data from a large statewide registry, patients undergoing PCI between July 2019 and March 2021 were studied. The primary measure of interest was ICI (intravascular ultrasound or optical coherence tomography) optimization during PCI. A fitted hierarchical Bayesian model identified variables independently associated with ICI optimization. The performing hospital and physician were included as random effects in the model. RESULTS Among 48 872 PCIs, ICI optimization was performed in 8094 (16.6%). Median [interquartile range] hospital- and physician-level frequencies of ICI were 8.8% [3.1%, 16.0%] and 6.1% [1.1%, 25.0%], respectively. Bayesian modeling identified left main PCI (adjusted odds ratio [aOR], 4.41; 95% credible interval [3.82, 5.10]), proximal left anterior descending artery PCI (aOR, 2.28 [2.00, 2.59]), PCI for in-stent restenosis (aOR, 1.55 [1.40, 1.72]), and surgical consult prior to PCI (aOR, 1.21 [1.07, 1.37]) as independent predictors of ICI optimization. The hospital-level median odds ratio, an estimate of the contribution of inter-hospital variability in odds of ICI use, was 3.48 (2.64, 5.04). Physician-level median odds ratio was 3.81 (3.33, 4.45). CONCLUSIONS Substantial hospital- and physician-level variation in ICI was observed. Except for performance of left main PCI, the hospital and physician performing the PCI were more strongly associated with ICI optimization than any patient or procedural factors.
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Affiliation(s)
- Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.)
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., D.S., H.S.G.)
| | - Devraj Sukul
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., D.S., H.S.G.)
| | - M Chadi Alraies
- Cardiovascular Institute, Wayne State University - Detroit Medical Center, MI (M.C.A.)
| | | | | | - Frank Saltiel
- Borgess Heart Center for Excellence, Ascension Borgess Hospital, Kalamazoo, MI (F.S.)
| | | | - Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., D.S., H.S.G.)
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16
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Phan QT, Nguyen HL, Lee WS, Won HY, Cho I, Shin SY, Hong JH, Lee JB, Kim SW. Impact of Reference Mismatch on Procedure Outcomes of Percutaneous Coronary Intervention. Angiology 2022; 74:417-426. [PMID: 36047931 DOI: 10.1177/00033197221123719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A significant mismatch between proximal and distal reference lumen diameters of the target lesion may pose challenges during percutaneous coronary intervention (PCI) and therefore influence the outcomes. We investigated total 1706 lesions underwent IVUS guided percutaneous coronary intervention, that were divided into 2 groups, including 411 lesions in Mismatch group and 1295 lesions in Non-Mismatch group. After propensity score matching, 397 lesions in each group were selected for final data set. The analysis showed that Mismatch group PCI required more frequently use of post-stenting optimization (79.6% vs 53.9%, P < .001) using higher max pressure (19.5 ± 3.9 vs 16.7 ± 3.7 atm, P < .001). Besides, Mismatch group also encountered more PCI major complications (7.8% vs 4.0%, P = .024) and lower procedure success rate (91.4% vs 95.5%, P = .022). On final angiogram, Mismatch group had smaller minimum lumen diameter (2.62 ± .45 vs 2.90 ± .57 mm, P < .001) and lower angiographic success rate (93.2% vs 96.7%, P = .023). On final IVUS, Mismatch group had higher rate of incomplete stent apposition and stent edge dissection (6.3% vs 3.0%, P = .029 and 2.5% vs .5%, P = .021, respectively). In conclusion, reference mismatch posed significant challenging during PCI that led to unfavorable procedural outcomes. These impacts may translate into long-term clinical implications that need to be addressed in future studies.
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Affiliation(s)
- Quang Tan Phan
- Intervention Center, Quang Nam Central National Hospital, Quang Nam, Vietnam.,Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Hieu Lan Nguyen
- Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam.,Intervention Center, Hanoi University Medical Center, Vietnam
| | - Wang Soo Lee
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Ho Youn Won
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Iksung Cho
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Seung Yong Shin
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Joon Hwa Hong
- Department of Cardiovascular Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Bae Lee
- Intervention Center, 58931Daegu Catholic University Medical Center, Daegu, Korea
| | - Sang Wook Kim
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
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17
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Ultrathin, Biodegradable-Polymer Sirolimus-Eluting Stent vs Thin, Durable-Polymer Everolimus-Eluting Stent. JACC Cardiovasc Interv 2022; 15:1324-1334. [DOI: 10.1016/j.jcin.2022.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
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18
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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: 23] [Impact Index Per Article: 11.5] [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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19
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Liu W, Yao Y, Jiang Z, Tian L, Song B, Liu H, Deng S, Luo R, Wei F. 3-Year outcomes in patients with heavily calcified lesions undergoing percutaneous coronary intervention using cutting balloons. BMC Cardiovasc Disord 2022; 22:187. [PMID: 35448940 PMCID: PMC9027752 DOI: 10.1186/s12872-022-02622-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) of heavily calcified lesions (HCLs) is associated with higher complication rates and worse clinical outcomes. Cutting balloon (CB) has been widely used for HCLs, but patients’ prognosis had not been fully clarified. The study aimed to compare 3-year clinical outcomes between patients with HCLs that are treated with CBs and those with non-HCLs. Method Patients who underwent PCI in Guizhou Provincial People’s Hospital from June 2015 to September 2018 were retrospectively included. HCL was defined as radiopaque and high-pressure undilatable lesions. CBs were routinely used in combination with non-compliant balloons for the HCLs. Major adverse cardiac event (MACE) and target vessel failure (TVF) were assessed at 3-year follow-up. Result Among 2432 patients included in the study, 210(8.6%) had HCLs with a procedural success rate of 91.0%. The patients with HCLs had a higher incidence of MACE (23.3% vs. 10.8%, P < 0.001) than those with non-HCLs. By propensity score matching, 172 patients with HCLs were 1:1 paired to those with non-HCLs, and their PCI vessels were exactly matched. The MACE and TVF were significantly higher in the patients with HCLs than those with non-HCLs (MACE: 21.5% vs. 13.4%, P = 0.036; TVF: 19.8% vs. 9.9%, P = 0.008). In the Cox regression analysis, HCL is independently associated with higher risks of MACE [HR: 1.72(1.01–2.94), P = 0.047], TVF [HR: 2.10(1.15–3.81), P = 0.015] and repeat revascularization [HR: 2.20(1.07–4.52), P = 0.032]. Conclusion Patients with HCLs undergoing PCI using CBs in combination with non-compliant balloons had higher risks of complications, procedural failure, and worse clinical outcomes at 3 years than those with non-HCLs. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02622-9.
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Affiliation(s)
- Wei Liu
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yutong Yao
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China. .,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China.
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Bo Song
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Hui Liu
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Shiyan Deng
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Rui Luo
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Fang Wei
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
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20
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Fujii K, Kubo T, Otake H, Nakazawa G, Sonoda S, Hibi K, Shinke T, Kobayashi Y, Ikari Y, Akasaka T. Expert consensus statement for quantitative measurement and morphological assessment of optical coherence tomography: update 2022. Cardiovasc Interv Ther 2022; 37:248-254. [PMID: 35167032 DOI: 10.1007/s12928-022-00845-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 12/16/2022]
Abstract
In this updated expert consensus document, the methods for the quantitative measurement and morphological assessment of optical coherence tomography (OCT)/optical frequency domain imaging images (OFDI) are briefly summarized. The focus is on the clinical application and the clinical evidence of OCT/OFDI to guide percutaneous coronary interventions.
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Affiliation(s)
- Kenichi Fujii
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata-city, Osaka, 5731010, Japan.
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Failure Therapy, Saga University Faculty of Medicine, Saga, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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21
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Lee PH, Hong SJ, Kim HS, Yoon YW, Lee JY, Oh SJ, Kang SJ, Kim YH, Park SW, Lee SW, Lee CW. Quantitative coronary angiography versus intravascular ultrasound guidance for drug-eluting stent implantation (GUIDE-DES): study protocol for a randomised controlled non-inferiority trial. BMJ Open 2022; 12:e052215. [PMID: 35027418 PMCID: PMC8762144 DOI: 10.1136/bmjopen-2021-052215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Angiography remains the gold standard for guiding percutaneous coronary intervention (PCI). However, it is prone to suboptimal stent results due to the visual estimation of coronary measurements. Although the benefit of intravascular ultrasound (IVUS)-guided PCI is becoming increasingly recognised, IVUS is not affordable for many catheterisation laboratories. Thus, a more practical and standardised angiography-based approach is necessary to support stent implantation. METHODS AND ANALYSIS The Quantitative Coronary Angiography versus Intravascular Ultrasound Guidance for Drug-Eluting Stent Implantation trial is a randomised, investigator-initiated, multicentre, open-label, non-inferiority trial comparing the quantitative coronary angiography (QCA)-guided PCI strategy with IVUS-guided PCI in all-comer patients with significant coronary artery disease. A novel, standardised, QCA-based PCI protocol for the QCA-guided group will be provided to all participating operators, while the PCI optimisation criteria will be predefined for both strategies. A total of 1528 patients will be randomised to either group at a 1:1 ratio. The primary endpoint is the 12-month cumulative incidence of target-lesion failure defined as a composite of cardiac death, target-vessel myocardial infarction or ischaemia-driven target-lesion revascularisation. Clinical follow-up assessments are scheduled at 1, 6 and 12 months for all patients enrolled in the study. ETHICS AND DISSEMINATION Ethics approval for this study was granted by the Institutional Review Board of Asan Medical Center (no. 2017-0060). Informed consent will be obtained from every participant. The study findings will be published in peer-reviewed journal articles and disseminated through public forums and academic conference presentations. Cost-effectiveness and secondary imaging analyses will be shared in secondary papers. TRIAL REGISTRATION NUMBER NCT02978456.
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Affiliation(s)
- Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Hyun-Sook Kim
- Department of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Korea (the Republic of)
| | - Young Won Yoon
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Jin Oh
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
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22
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Improving PCI Outcomes Using Postprocedural Physiology and Intravascular Imaging. JACC Cardiovasc Interv 2021; 14:2415-2430. [PMID: 34794649 DOI: 10.1016/j.jcin.2021.08.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
Although clinical outcomes after percutaneous coronary intervention (PCI) are improving, the long-term risk for target vessel failure remains concerning. Although the application of intravascular imaging and physiological indexes significantly improves outcomes, their routine use in practice remains limited. Nevertheless, merely using these modalities is not enough, and to truly improve patient outcomes, optimal intravascular dimensions with minimal vascular injury should be targeted. When assessing post-PCI results using either type of physiological or imaging technology, a broad spectrum of stent- and vessel-related anomalies can be expected. As not all of these issues warrant treatment, a profound knowledge of what to expect and how to recognize and when to treat these intraluminal problems is needed. Additionally, promising new modalities such as angiography-derived coronary physiology and hybrid imaging catheters are becoming available. The authors provide an overview of the currently available tools and techniques to define suboptimal PCI and when to apply these technologies to improve outcomes.
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23
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Choi IJ, Lim S, Choo EH, Hwang BH, Kim CJ, Park MW, Lee JM, Park CS, Kim HY, Yoo KD, Jeon DS, Youn HJ, Chung WS, Kim MC, Jeong MH, Ahn Y, Chang K. Impact of Intravascular Ultrasound on Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2021; 14:2431-2443. [PMID: 34756537 DOI: 10.1016/j.jcin.2021.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to examine the impact of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) on long-term clinical outcomes in patients with acute myocardial infarction (AMI). BACKGROUND IVUS-guided PCI has been associated with improved cardiovascular outcomes. However, the beneficial effect of IVUS-guided PCI in patients with AMI in the drug-eluting stent era remains unclear. METHODS Patients who underwent PCI with drug-eluting stents were selected from 10,719 patients enrolled in a multicenter AMI registry. The included patients were classified into 2 groups according to the use or nonuse of IVUS. The primary outcome was a composite of major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, and target lesion revascularization, during long-term follow-up. RESULTS A total of 9,846 patients were treated with IVUS-guided PCI (n = 2,032) or angiography-guided PCI (n = 7,814). IVUS-guided PCI was associated with reduced MACE (HR: 0.779; 95% CI: 0.689-0.880; P < 0.001). The results were consistent after multivariable regression and propensity score matching. One-year landmark analysis showed a lower risk for MACE within 1 year (HR: 0.766; 95% CI: 0650-0.903; P = 0.002) and beyond 1 year (HR: 0.796; 95% CI: 0663-0.956; P = 0.014) after index PCI. CONCLUSIONS The use of IVUS was associated with better long-term cardiovascular outcomes. The clinical benefit of IVUS was maintained both within and beyond 1 year after index PCI. The use of IVUS in PCI should be considered for patients with AMI.
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Affiliation(s)
- Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hee Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's hospital, The Catholic University of Korea, Seoul, Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min Chul Kim
- Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea
| | - Youngkeun Ahn
- Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea
| | - Kiyuk Chang
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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24
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Wongpraparut N, Bakoh P, Anusonadisai K, Wongsawangkit N, Tresukosol D, Chotinaiwattarakul C, Phankingthongkum R, Tungsubutra W, Chunhamaneewat N, Towashiraporn K, Phichaphop A, Panchavinnin P, Pongakasira R, Panchavinnin P. Intravascular Imaging Guidance Reduce 1-Year MACE in Patients Undergoing Rotablator Atherectomy-Assisted Drug-Eluting Stent Implantation. Front Cardiovasc Med 2021; 8:768313. [PMID: 34778419 PMCID: PMC8578321 DOI: 10.3389/fcvm.2021.768313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to investigate the incidence of 1-year major adverse cardiac events (MACE) compared between intravascular imaging guidance and angiographic guidance in patients undergoing rotablator atherectomy (RA)-assisted percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Methods: This retrospective analysis included 265 consecutive patients with heavy calcified lesion who underwent RA-assisted PCI with DES implantation at our institution during the January 2016-December 2018 study period. This study was approved by the Siriraj Institutional Review Board. Patients were divided into either the angiographic guidance PCI group or the imaging guidance PCI group, which was defined as intravascular ultrasound or optical coherence tomography. The primary endpoint was 1-year MACE. Results: Two hundred and sixty-five patients were enrolled, including 188 patients in the intravascular imaging guidance group, and 77 patients in the angiographic guidance group. One-year MACE was significantly lower in the imaging guidance group compared to the angiographic guidance group (4.3 vs. 28.9%, respectively; odds ratio (OR): 9.06, 95% CI: 3.82–21.52; p < 0.001). The 1-year rates of all-cause death (OR: 8.19, 95% CI: 2.15–31.18; p = 0.002), myocardial infarction (MI) (OR: 6.13, 95% CI: 2.05–18.3; p = 0.001), and target vessel revascularization (TVR) (OR: 3.67, 95% CI: 1.13–11.96; p = 0.031) were also significantly lower in the imaging guidance group compared with the angiographic guidance group. The rate of stroke was non-significantly different between groups. Conclusion: In patients with heavy calcified lesion undergoing RA-assisted DES implantation, the intravascular imaging guidance significantly reduced the incidence of 1-year MACE, all-cause death, MI, and TVR compared to the angiographic guidance.
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Affiliation(s)
- Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paroj Bakoh
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kawin Anusonadisai
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Namthip Wongsawangkit
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Damras Tresukosol
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Rewat Phankingthongkum
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wiwun Tungsubutra
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narathip Chunhamaneewat
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Korakoth Towashiraporn
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Asa Phichaphop
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pariya Panchavinnin
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungtiwa Pongakasira
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Pradit Panchavinnin
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Richards G, Johnson T. A Vision Of Percutaneous Coronary Revascularisation In 2021: How to take advantage of intra-coronary imaging to perform more effective PCI. JRSM Cardiovasc Dis 2021; 10:20480040211049978. [PMID: 35186282 PMCID: PMC8851127 DOI: 10.1177/20480040211049978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
The use of intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) can define vessel architecture and has an established role in guidance and optimisation of percutaneous coronary intervention. Additionally intracoronary imaging has an emerging role in diagnosis, afforded by the ability to depict vessel wall characteristics not seen on angiography alone. Use of intracoronary imaging is recommended by international consensus guidelines from the European Society of Cardiology and two recent expert consensus position statements from the European Association of Percutaneous Coronary Interventions (EAPCI). However, uptake in contemporary practice in the United Kingdom appears to lag behind these recommendations. Imaging is particularly advantageous in complex coronary lesions (such as left main stem coronary artery, bifurcation, or heavily calcified lesions) and in complex patients (acute presentations, atypical presentations, and renal dysfunction). Stent detail to the level of individual struts can be appreciated with intracoronary imaging, which facilitates appropriate stent selection and optimisation of the final stent result. We highlight specific subgroups that benefit from an imaging guided approach to percutaneous coronary intervention. We review the evidence and the role of intracoronary imaging and highlight specific subgroups that show particular benefit from imaging guided percutaneous coronary intervention.
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Affiliation(s)
- Gavin Richards
- Bristol Heart Institute, Bristol, UK of Great Britain and Northern Ireland
| | - Thomas Johnson
- Bristol Heart Institute, Bristol, UK of Great Britain and Northern Ireland
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26
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Kang DY, Ahn JM, Yun SC, Park H, Cho SC, Kim TO, Park S, Lee PH, Lee SW, Park SW, Park DW, Park SJ. Long-Term Clinical Impact of Intravascular Ultrasound Guidance in Stenting for Left Main Coronary Artery Disease. Circ Cardiovasc Interv 2021; 14:e011011. [PMID: 34665659 DOI: 10.1161/circinterventions.121.011011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Do-Yoon Kang
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Cheol Yun
- Division of Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanbit Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Cheol Cho
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Oh Kim
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sangwoo Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Hyung Lee
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cha JJ, Kim D, Kim BK, Hong SJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Association between angiographic and intravascular ultrasound optimizations after new-generation drug-eluting stent implantation and clinical outcomes. Coron Artery Dis 2021; 32:541-548. [PMID: 33471477 DOI: 10.1097/mca.0000000000001007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Uncertainty remains regarding the associations of angiographic optimization and intravascular ultrasound (IVUS) optimization after new-generation drug-eluting stent (DES) implantation. METHODS From four randomized trials comparing outcomes between IVUS and angiography-guidance for long or chronic total occlusion (CTO) lesions, 1396 patients who underwent IVUS-guided new-generation DES implantation were enrolled. Of these, 1112 patients (80%) met angiographic optimization criteria (postprocedural diameter stenosis, ≤20%) and were further classified into the matched (same results for angiographic optimization and IVUS optimization) and the mismatched group (opposite results for angiographic optimization and IVUS optimization) according to the meeting of IVUS optimization criteria (minimal stent area, ≥5.5 mm2 or ≥80% of mean reference lumen area). The major adverse clinical events (MACE) were compared. RESULTS Of 1112 patients with angiographic optimization, 675 patients met the IVUS optimization criteria (61%; matched), but 437 patients (39%; mismatched) failed to meet IVUS optimization criteria (false-positive rate = 76%). On multivariate analyses, age >60 years, reference vessel diameter ≤2.7 mm, left circumflex artery and lesion length ≥33 mm were significant predictors for the mismatched. When comparing the 12-month MACE rates, the mismatched group (6.8%) showed a significantly higher rate than the matched group (1.5%; hazard ratio = 2.62; 95% confidence interval = 1.20-5.72; P = 0.012), mainly driven by a higher target-vessel revascularization rate (6.4 vs 1.4%; P = 0.021). CONCLUSION Despite meeting angiographic optimization criteria in long or CTO lesions, more than one-third of the patients with IVUS-guided new-generation DES implantation failed to meet the IVUS optimization criteria and had worse clinical outcomes. Therefore, IVUS optimization should be considered for patients who had predictors of mismatch.
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Affiliation(s)
- Jung-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Byeong-Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Sung-Jin Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Chul-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Jung-Sun Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
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Hong SJ, Kim D, Kim BK, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Acute and one-year clinical outcomes of pre-stenting intravascular ultrasound: a patient-level meta-analysis of randomised clinical trials. EUROINTERVENTION 2021; 17:202-211. [PMID: 32364499 PMCID: PMC9753928 DOI: 10.4244/eij-d-20-00276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pre-stenting intravascular ultrasound (IVUS) assessment is helpful for appropriate stent sizing and determination of the stent landing zone during percutaneous coronary intervention. AIMS The aim of this meta-analysis was to investigate the effect of pre-stenting IVUS evaluation on procedural and clinical outcomes for diffuse lesions treated with drug-eluting stents (DES). METHODS In four randomised trials comparing IVUS- and angiography-guided DES placement, a total of 1,396 patients who underwent DES implantation with IVUS guidance were identified. Pre-stenting IVUS assessment was performed in 905 patients along with post-stenting IVUS (65%; pre-stenting IVUS(+) group). Post-stenting IVUS evaluation alone was conducted on 491 patients (35%; pre-stenting IVUS(-) group). RESULTS The pre-stenting IVUS(+) group had a larger angiographic minimal lumen diameter and IVUS-derived minimal stent area (MSA) than did the pre-stenting IVUS(-) group. After adjusting, these findings were consistent. The one-year composite of cardiac death, myocardial infarction, and target vessel revascularisation did not differ between the groups. In subgroup analysis, the pre-IVUS(+) group was significantly favoured over the pre-IVUS(-) group in the subset of patients with acute myocardial infarction and lesions with small vessels in terms of larger MSA, and in the subset of patients with chronic total occlusions in terms of better clinical outcomes. CONCLUSIONS Pre-stenting IVUS assessment prior to DES placement was associated with better acute procedural outcomes, though this did not translate into one-year clinical outcomes in the context of post-stenting IVUS assessment. Visual summary. Acute and one-year outcomes of pre-stenting intravascular ultrasound: a meta-analysis of randomised clinical trials.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Daehoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Bajaj R, Huang X, Kilic Y, Ramasamy A, Jain A, Ozkor M, Tufaro V, Safi H, Erdogan E, Serruys PW, Moon J, Pugliese F, Mathur A, Torii R, Baumbach A, Dijkstra J, Zhang Q, Bourantas CV. Advanced deep learning methodology for accurate, real-time segmentation of high-resolution intravascular ultrasound images. Int J Cardiol 2021; 339:185-191. [PMID: 34153412 DOI: 10.1016/j.ijcard.2021.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study is to develop and validate a deep learning (DL) methodology capable of automated and accurate segmentation of intravascular ultrasound (IVUS) image sequences in real-time. METHODS AND RESULTS IVUS segmentation was performed by two experts who manually annotated the external elastic membrane (EEM) and lumen borders in the end-diastolic frames of 197 IVUS sequences portraying the native coronary arteries of 65 patients. The IVUS sequences of 177 randomly-selected vessels were used to train and optimise a novel DL model for the segmentation of IVUS images. Validation of the developed methodology was performed in 20 vessels using the estimations of two expert analysts as the reference standard. The mean difference for the EEM, lumen and plaque area between the DL-methodology and the analysts was ≤0.23mm2 (standard deviation ≤0.85mm2), while the Hausdorff and mean distance differences for the EEM and lumen borders was ≤0.19 mm (standard deviation≤0.17 mm). The agreement between DL and experts was similar to experts' agreement (Williams Index ranges: 0.754-1.061) with similar results in frames portraying calcific plaques or side branches. CONCLUSIONS The developed DL-methodology appears accurate and capable of segmenting high-resolution real-world IVUS datasets. These features are expected to facilitate its broad adoption and enhance the applications of IVUS in clinical practice and research.
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Affiliation(s)
- Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Xingru Huang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, UK
| | - Yakup Kilic
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Ajay Jain
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mick Ozkor
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Hannah Safi
- Department of Mechanical Engineering, University College London, London, UK
| | - Emrah Erdogan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, UK
| | - James Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Jouke Dijkstra
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | - Qianni Zhang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
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Clinical Implications of Post-Stent Optical Coherence Tomographic Findings: Severe Malapposition and Cardiac Events. JACC Cardiovasc Imaging 2021; 15:126-137. [PMID: 34023255 DOI: 10.1016/j.jcmg.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the impact of post-stent optical coherence tomography (OCT) findings, including severe malapposition, on long-term clinical outcomes. BACKGROUND Suboptimal OCT findings following percutaneous coronary intervention (PCI) are highly prevalent; however, their clinical implications remain controversial. METHODS Of the patients registered in the Yonsei OCT registry, a total of 1,290 patients with 1,348 lesions, who underwent OCT immediately post-stenting, were consecutively enrolled for this study. All patients underwent implantation of drug-eluting stents. Post-stent OCT findings were assessed to identify predictors of device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction (MI) or stent thrombosis, and target lesion revascularization (TLR). Significant malapposition criteria associated with major safety events (MSE) were also investigated, such as cardiac death, target vessel-related MI, or stent thrombosis. RESULTS The median follow-up period was 43.0 months (interquartile range [IQR] 21.4 to 56.0 months). The incidence rates of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of DoCE. However, patients with significant malapposition (total malapposition volume [TMV] ≥7.0 mm3] exhibited more frequent MSE. A smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR]: 1.20 [95% confidence interval [CI]: 1.00 to 1.43]; p = 0.045). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of MSE (HR: 6.12 [95% CI: 1.88 to 19.95]; p = 0.003). Follow-up OCT at 3, 6, or 9 months after PCI showed that post-stent TMV ≥7.0 mm3 was related to a greater occurrence of late malapposition and uncovered struts. CONCLUSIONS Although most suboptimal OCT findings were not associated with clinical outcomes, a smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more MSE after PCI. (Yonsei OCT [Optical Coherence Tomography] Registry for Evaluation of Efficacy and Safety of Coronary Stenting; Yonsei OCT registry; NCT02099162).
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31
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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 2021; 13:1880-1890. [PMID: 32819477 DOI: 10.1016/j.jcin.2020.04.052] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Bajaj R, Garcia-Garcia HM, Courtney BK, Ramasamy A, Tufaro V, Erdogan E, Khan AH, Alves N, Rathod KS, Onuma Y, Serruys PW, Mathur A, Baumbach A, Bourantas C. Multi-modality intravascular imaging for guiding coronary intervention and assessing coronary atheroma: the Novasight Hybrid IVUS-OCT system. Minerva Cardiol Angiol 2021; 69:655-670. [PMID: 33703857 DOI: 10.23736/s2724-5683.21.05532-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intravascular imaging has evolved alongside interventional cardiology as an adjunctive tool for assessing plaque pathology and for guiding and optimising percutaneous coronary intervention (PCI) in challenging lesions. The two modalities which have dominated the field are intravascular ultrasound (IVUS), which relies on sound waves and optical coherence tomography (OCT), relying on light waves. These approaches however have limited efficacy in assessing plaque morphology and vulnerability that are essential for guiding PCI in complex lesions and identifying patient at risk that will benefit from emerging therapies targeting plaque evolution. These limitations are complementary and, in this context, it has been recognised and demonstrated in multi-modality studies that the concurrent use of IVUS and OCT can help overcome these deficits enabling a more complete and accurate plaque assessment. The Conavi Novasight Hybrid IVUS-OCT catheter is the first commercially available device that is capable of invasive clinical coronary assessment with simultaneously acquired and co-registered IVUS and OCT imaging. It represents a significant evolution in the field and is expected to have broad application in clinical practice and research. In this review article we present the limitations of standalone intravascular imaging techniques, summarise the data supporting the value of multimodality imaging in clinical practice and research, describe the Novasight Hybrid IVUS-OCT system and highlight the potential utility of this technology in coronary intervention and in the study of atherosclerosis.
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Affiliation(s)
- Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Brian K Courtney
- Sunnybrook Research Institute, Schulich Heart Program, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Emrah Erdogan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ameer H Khan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Natasha Alves
- Sunnybrook Research Institute, Schulich Heart Program, University of Toronto, Toronto, ON, Canada
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Yoshinobu Onuma
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK - .,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
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33
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Malaiapan Y, Leung M, White AJ. The role of intravascular ultrasound in percutaneous coronary intervention of complex coronary lesions. Cardiovasc Diagn Ther 2020; 10:1371-1388. [PMID: 33224763 DOI: 10.21037/cdt-20-189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intravascular ultrasound (IVUS) is a catheter-based coronary imaging technique. It utilises the emission & subsequent detection of reflected high frequency (30-60 MHz) sound waves to create high resolution, cross-sectional images of the coronary artery. IVUS has been the cornerstone of intracoronary imaging for more than two decades. When compared to the invasive coronary angiogram which studies only the silhouette of the contrast-filled artery lumen, IVUS also crucially images the vessel wall. Because of this capability, IVUS has greatly facilitated understanding of the coronary atherosclerosis process. Such insights from IVUS reveal how commonly and extensively plain angiography underestimates the true extent of coronary plaque, the characteristics of plaques prone to rupture and cause acute coronary syndromes (lipid rich, thin cap atheroma), and a realisation of the widespread occurrence of vessel remodelling in response to atherosclerosis. Similarly, IVUS has historically provided salutary mechanistic insights that have guided many of the incremental advances in the techniques of percutaneous coronary intervention (PCI). Examples include mechanisms of in-stent restenosis, and the importance of high-pressure post-dilatation of stents to ensure adequate stent apposition and thereby reduce the occurrence of stent thrombosis. IVUS also greatly facilitates the choice of correct diameter and length of stent to implant. Overall, a compelling body of evidence indicates that use of intravascular ultrasound in PCI helps to achieve optimal technical results and to mitigate the risk of adverse cardiac events. In this review, the role of intravascular ultrasound as an adjunct to PCI in complex coronary lesions is explored. The complex coronary situations discussed are the left main stem, ostial stenoses, bifurcation stenoses, thrombotic lesions, the chronically occluded coronary artery, and calcified coronary artery disease. By thorough review of the available evidence, we establish that the advantages of IVUS guidance are particularly evident in each of these complex CAD subsets. In particular, some consider the use of IVUS to be almost mandatory in left main PCI. A comparison with other intracoronary imaging techniques is also explored.
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Affiliation(s)
- Yuvaraj Malaiapan
- Monash Heart, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Michael Leung
- Monash Heart, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Anthony J White
- Monash Heart, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
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Nogic J, Prosser H, O'Brien J, Thakur U, Soon K, Proimos G, Brown AJ. The assessment of intermediate coronary lesions using intracoronary imaging. Cardiovasc Diagn Ther 2020; 10:1445-1460. [PMID: 33224767 DOI: 10.21037/cdt-20-226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intermediate coronary artery stenosis, defined as visual angiographic stenosis severity of between 30-70%, is present in up to one quarter of patients undergoing coronary angiography. Patients with this particular lesion subset represent a distinct clinical challenge, with operators often uncertain on the need for revascularization. Although international guidelines appropriately recommend physiological pressure-based assessment of these lesions utilizing either fractional flow reserve (FFR) or quantitative flow ratio (QFR), there are specific clinical scenarios and lesion subsets where the use of such indices may not be reliable. Intravascular imaging, mainly utilizing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represents an alternate and at times complementary diagnostic modality for the evaluation of intermediate coronary stenoses. Studies have attempted to validate these specific imaging measures with physiological markers of lesion-specific ischaemia with varied results. Intravascular imaging however also provides additional benefits that include portrayal of plaque morphology, guidance on stent implantation and sizing and may portend improved clinical outcomes. Looking forward, research in computational fluid dynamics now seeks to integrate both lesion-based physiology and anatomical assessment using intravascular imaging. This review will discuss the rationale and indications for the use of intravascular imaging assessment of intermediate lesions, while highlighting the current limitations and benefits to this approach.
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Affiliation(s)
- Jason Nogic
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia.,Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Hamish Prosser
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph O'Brien
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Kean Soon
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - George Proimos
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
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35
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Megaly M, Pershad A, Glogoza M, Elbadawi A, Omer M, Saad M, Mentias A, Elgendy I, Burke MN, Capodanno D, Brilakis ES. Use of Intravascular Imaging in Patients With ST-Segment Elevation Acute Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 30:59-64. [PMID: 33032963 DOI: 10.1016/j.carrev.2020.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use and impact of intravascular imaging in ST-elevation myocardial infarction (STEMI) patients has received limited study. METHODS We queried the National Inpatient Sample database (NIS) between January 2016 and December 2017 to identify hospitalizations of STEMI patients who underwent percutaneous coronary intervention (PCI). We used a 1:2 propensity-score (PS) matched analysis to compare in-hospital outcomes in patients with vs. without use of intravascular imaging. We conducted a multivariable regression analysis to identify variables independently associated with in-hospital mortality. RESULTS We identified 252,970 weighted discharges of PCI in STEMI patients, 5.5% of which included intravascular imaging. Patients in whom intravascular imaging was used were more likely to have acute stent thrombosis (4.7% vs. 1.4%, p < 0.001) and present with anterior STEMI (48.1% vs. 39.1%, p < 0.001). After PS matching (intravascular imaging n = 14,015, no intravascular imaging n = 28,025), the use of intravascular imaging was associated with lower in-hospital mortality (3.6% vs. 4.8%, p = 0.010). The risk of in-hospital complications and discharge to a facility (nursing facility or short-term acute hospital) was similar between both groups before and after PS matching. The use of intravascular imaging was associated with a higher index hospitalization cost [$25,218 vs. $20,515, p < 0.001]. On multivariable analysis, intravascular imaging was independently associated with lower in-hospital mortality [OR 0.735 (95% CI 0.662-0.816), p < 0.001]. CONCLUSION Intravascular imaging was used in 5.5% of PCIs in STEMI patients and was independently associated with lower in-hospital mortality and higher index hospitalization cost.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | - Matthew Glogoza
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamed Omer
- Division of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Marwan Saad
- Division of Cardiology, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Amgad Mentias
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Islam Elgendy
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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36
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Wilkinson SE, Madder RD. Intracoronary near-infrared spectroscopy-role and clinical applications. Cardiovasc Diagn Ther 2020; 10:1508-1516. [PMID: 33224770 DOI: 10.21037/cdt.2020.02.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intracoronary near-infrared spectroscopy (NIRS) has been developed and validated for the detection of lipid-rich plaque in the coronary arteries. A combined NIRS and intravascular ultrasound catheter is currently in clinical use and has an emerging role in evaluating plaques both before and after percutaneous coronary intervention. NIRS has recently been shown to positively identify both vulnerable patients and vulnerable plaques. This review focuses on the principles and image interpretation of intracoronary NIRS, as well as its clinical applications, limitations, and future directions.
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Affiliation(s)
- Stephen E Wilkinson
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
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37
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Noble C, Carlson K, Neumann E, Lewis B, Dragomir-Daescu D, Lerman A, Erdemir A, Young M. Ex Vivo Evaluation of IVUS-VH Imaging and the Role of Plaque Structure on Peripheral Artery Disease. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2020; 8. [PMID: 34291202 DOI: 10.1016/j.medntd.2020.100042] [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: 10/23/2022] Open
Abstract
Peripheral artery disease (PAD) results from the buildup of atherosclerotic plaque in the arterial wall, can progress to severe ischemia and lead to tissue necrosis and limb amputation. We evaluated a means of assessing PAD mechanics ex vivo using ten human peripheral arteries with PAD. Pressure-inflation testing was performed at six physiological pressure intervals ranging from 10-200 mmHg. These vessels were imaged with IVUS-VH to determine plaque composition and change in vessel structure with pressure. Statistical analysis was performed to determine which plaque structures and distributions of these structures had the greatest influence on wall deformation. We found that fibrous plaque, necrotic core, and calcification had a statistically significant effect on all variables (p<0.05). The presence of large concentrations of fibrous plaque was linked to reduced vessel compliance and ellipticity, which could lead to stent fractures and restenosis. For the plaque distribution we found that clustered necrotic core increased overall compliance while clustered calcification decreased overall compliance. The effect of plaque distribution on vessel wall deformation must be considered equally important to plaque concentration.
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Affiliation(s)
- Christopher Noble
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent Carlson
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Erica Neumann
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Lewis
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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38
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Kim D, Hong SJ, Kim BK, Shin DH, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Outcomes of stent optimisation in intravascular ultrasound-guided interventions for long lesions or chronic total occlusions. EUROINTERVENTION 2020; 16:e480-e488. [DOI: 10.4244/eij-d-19-00762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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39
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Simon EJ, Ziccardi MR, Dickens H, Young MN, Shroff A. Better Is the Evolution of Good: How IVUS and OCT Have Transformed PCI. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09544-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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40
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Gao XF, Kong XQ, Zuo GF, Wang ZM, Ge Z, Zhang JJ. Intravascular Ultrasound-guided Versus Angiography-guided Percutaneous Coronary Intervention: Evidence from Observational Studies and Randomized Controlled Trials. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary angiography has been considered the gold standard for the diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). However, 2D-projection angiography cannot completely reflect the 3D coronary lumen. Intravascular ultrasound (IVUS) can overcome a number of limitations of coronary angiography by providing more information about the dimensions of the vessel lumen, plaque characteristics, stent deployment, and the mechanisms of device failure. Growing data from observational studies and randomized controlled trials have confirmed the clinical benefit of IVUS guidance during PCI. This article summarizes the evidence regarding IVUS guidance to highlight its advantages and to support the use of IVUS during PCI.
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Affiliation(s)
- Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guang-Feng Zuo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhi-Mei Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Shlofmitz E, Torguson R, Zhang C, Craig PE, Mintz GS, Khalid N, Chen Y, Rogers T, Hashim H, Ben-Dor I, Garcia-Garcia HM, Satler LF, Waksman R. Impact of Intravascular Ultrasound on Outcomes Following PErcutaneous Coronary InterventioN in Complex Lesions (iOPEN Complex). Am Heart J 2020; 221:74-83. [PMID: 31951847 DOI: 10.1016/j.ahj.2019.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/07/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Clinical data support the use of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) as being associated with improved outcomes. Nonetheless, global utilization of IVUS remains low. We hypothesize that, in the revascularization of complex lesions, IVUS use is associated with improved outcomes. METHODS All patients with complex lesions treated with PCI at a single center from 2003 to 2016 were stratified by use of IVUS. Complex lesions were defined as follows: American College of Cardiology/American Heart Association type C lesions, in-stent restenosis, long lesions, bifurcations, severe calcification, left main lesions, and chronic total occlusions. The primary end point was the rate of major adverse cardiac events (MACE) at 1-year follow-up, defined as the composite of all-cause mortality, Q-wave myocardial infarction, and target vessel revascularization. Inverse probability weighting was used in the adjusted analysis. RESULTS A total of 6,855 patients were included in the final analysis, of whom 67.3% had IVUS and 32.7% had angiography alone. The primary end point occurred in 13.4% of patients treated with IVUS and 18.3% of patients treated with angiography alone (P < .001). Inverse probability weighting-adjusted 1-year MACE rates demonstrated significant reduction with IVUS for each complex lesion type. CONCLUSIONS Among patients with complex lesions, the use of IVUS was associated with lower MACE 1 year after PCI than angiography alone was. Because of the increased procedural risk in complex lesions, routine utilization of IVUS-guided PCI should be considered in this subset of patients.
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Fifteen years of coronary intravascular ultrasound in percutaneous coronary intervention in Portugal. Rev Port Cardiol 2020; 38:779-785. [PMID: 32057522 DOI: 10.1016/j.repc.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/20/2019] [Accepted: 02/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Coronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal. METHODS A retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized. RESULTS A total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C-type or bifurcated coronary lesions, and in-stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery. CONCLUSION Coronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery.
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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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Guerreiro RA, Fernandes R, Teles RC, Silva PCD, Pereira H, Ferreira RC, Costa M, Seixo F, Abreu PFE, Pipa JL, Bernardes L, Machado FP, Palos J, Oliveira EID, Carvalho HC, Silva JC, Caires G, Martins D, Baptista J, Calisto J, Santos RPD, Matias F, Costa J, Sousa P, Ribeiro VG, Fiarresga A, Silveira JBD. 15 years of coronary intravascular ultrasound in percutaneous coronary intervention in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kumar A, Shariff M, Adalja D, Doshi R. Intravascular ultrasound versus angiogram guided drug eluting stent implantation. A systematic review and updated meta-analysis with trial sequential analysis. IJC HEART & VASCULATURE 2019; 25:100419. [PMID: 31517035 PMCID: PMC6732761 DOI: 10.1016/j.ijcha.2019.100419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/23/2023]
Abstract
Background Further advances have been achieved in the field of intravenous ultrasound (IVUS) guided drug eluting stent (DES) implantation and hence there was a need to rejuvenate the evidence. Hence, we performed a cumulative meta-analysis with trial sequential analysis (TSA) of randomized controlled trials (RCTs) comparing IVUS versus angiogram guided DES implantation. Methodology We searched PubMed/Medline and Cochrane database for relevant articles using predefined inclusion and exclusion criteria. Outcomes of interest were cardiovascular mortality, myocardial infarction (MI), target lesion revascularisation (TLR), stent thrombosis (ST). We used Mantel-Haenszel method with random error model to calculate odds ratio (OR) with 95% confidence interval (CI). We also performed TSA to accommodate for possible type I error. Results A total of 11 RCTs with 5352 patients were included in the final analysis. Follow up duration of included studies varied from 12 to 24 months. IVUS use was associated with significantly reduced incidence of cardiovascular mortality [OR: 0.45, CI: 0.25–0.80, p value = 0.007, I2 = 0%, χ2p-value = 0.98], TLR [OR: 0.56, CI: 0.41–0.77, p value = 0.0004, I2 = 0%, χ2p-value = 0.95] and ST [OR: 0.47, CI: 0.24–0.94, p value = 0.03, I2 = 0%, χ2p-value = 0.75]. IVUS use had no effect on incidence of MI on follow up. The cumulative z curve crosses the TSA boundary indicating sufficient evidence without type I error for reduced incidence of cardiovascular mortality and TLR with the use IVUS. Conclusion IVUS-guided DES implantation should be the standard of care as it significantly reduced cardiovascular mortality and TLR.
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Affiliation(s)
- Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Devina Adalja
- Department of Medicine, Gotri Medical Education and Research Centre, Vadodara, Gujarat, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
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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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Hiraya D, Sato A, Hoshi T, Sakai S, Watabe H, Ieda M. Incidence, retrieval methods, and outcomes of intravascular ultrasound catheter stuck within an implanted stent: Systematic literature review. J Cardiol 2019; 75:164-170. [PMID: 31416780 DOI: 10.1016/j.jjcc.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND There have been no reviews regarding intravascular ultrasound (IVUS) catheter entrapment during percutaneous coronary intervention (PCI). This study investigated the incidence, retrieval methods, and outcomes of IVUS catheter stuck within implanted stents. METHODS Between January 2015 and July 2018, a total of 794 consecutive patients underwent PCI for coronary artery disease. Among them, 705 patients underwent stent implantation using IVUS. The patients with IVUS catheter entrapment in an implanted stent were investigated. RESULTS Ten patients (1.4%) suffered from an IVUS catheter stuck in an implanted stent. Among them, 7 patients had very tortuous lesions while 5 patients had severely calcified lesions. Seven patients (70%) underwent placement of the 3rd generation drug-eluting stent (DES), and the stent diameters were ≤2.5mm among 8 patients (80%). Retrieval methods were the buddy wire technique, the double guide catheter technique, covering the exit port of IVUS catheter with a balloon catheter, and covering with GuideLiner® catheter (Vascular Solutions Inc., Minneapolis, MN, USA). On multivariable analysis, the predictors of IVUS catheter entrapment were tortuous lesion [odds ratio (OR), 8.21; 95% confidence interval (CI), 2.19-30.7; p=0.002], 3rd generation DES (OR, 5.31; 95% CI, 1.08-26.1; p=0.021), and stent diameter ≤2.5mm (OR, 6.31; 95% CI, 1.29-30.8; p=0.010). Furthermore, we identified 6 cases of IVUS catheter entrapment through a systematic literature review. CONCLUSIONS The IVUS catheter was almost stuck in tortuous lesions and the 3rd generation DES with a small diameter. We could successfully retrieve it in all cases using various retrieval techniques.
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Affiliation(s)
- Daigo Hiraya
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shunsuke Sakai
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroaki Watabe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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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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Elgendy IY, Mahmoud AN, Elgendy AY, Mintz GS. Intravascular Ultrasound-Guidance Is Associated With Lower Cardiovascular Mortality and Myocardial Infarction for Drug-Eluting Stent Implantation ― Insights From an Updated Meta-Analysis of Randomized Trials ―. Circ J 2019; 83:1410-1413. [DOI: 10.1253/circj.cj-19-0209] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Islam Y. Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida
| | - Ahmed N. Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida
| | - Akram Y. Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida
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Saito Y, Kitahara H, Okuya Y, Nakayama T, Fujimoto Y, Kobayashi Y. Novel predictor of target vessel revascularization after coronary stent implantation: Intraluminal intensity of blood speckle on intravascular ultrasound. Catheter Cardiovasc Interv 2019; 93:604-610. [PMID: 30269414 DOI: 10.1002/ccd.27859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/21/2018] [Accepted: 08/10/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The difference in intraluminal intensity of blood speckle (IBS) on integrated backscatter-intravascular ultrasound (IB-IVUS) across the coronary artery stenosis (i.e., ΔIBS) has been reported to negatively correlate with fractional flow reserve. Fractional flow reserve after coronary stenting is known as a predictor of target vessel revascularization (TVR). However, the relation between ΔIBS and TVR is unclear. METHODS Seven hundred and three vessels which underwent percutaneous coronary intervention with stents were screened. Vessels without IVUS-guidance and follow-up information were excluded. Intraluminal IBS values were measured using IB-IVUS in cross-sections at the ostium of the target vessel and at the distal reference of implanted stent. ΔIBS was calculated as (distal IBS) - (ostium IBS). RESULTS A total of 393 vessels were included. Mean ΔIBS at postprocedure was 6.22 ± 5.65. During the follow-up period (11.2 ± 3.1 months), 24 cases (6.1%) had TVR. ΔIBS was significantly greater in the vessels with TVR than in those without (11.10 ± 5.93 vs. 5.90 ± 5.49, P <0.001). In receiver operating characteristic curve analysis, ΔIBS significantly predicted TVR (AUC 0.74, best cut-off value 8.24, P < 0.001). Multiple logistic regression analysis showed use of drug eluting stent and ΔIBS ≥ 8.24 as independent predictors of TVR. CONCLUSIONS ΔIBS at postprocedure was significantly associated with TVR. IVUS may be able to predict TVR by physiological assessment with measurement of ΔIBS.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshiyuki Okuya
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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