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Ahmed M, Javaid H, Talha Maniya M, Shafiq A, Shahbaz H, Singh P, Jain H, Basit J, Hamza M, Nashwan AJ, Ali S, Vadamalai K. Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention: A meta-analysis of randomized controlled trials. IJC HEART & VASCULATURE 2024; 52:101405. [PMID: 38854743 PMCID: PMC11156695 DOI: 10.1016/j.ijcha.2024.101405] [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: 01/16/2024] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 06/11/2024]
Abstract
Background Optical Coherence Tomography (OCT), a high-resolution imaging modality, guides stent implantation during percutaneous coronary intervention (PCI). However, OCT-guided PCI safety and efficacy data is limited. Methods MEDLINE, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) comparing OCT-guided PCI to Angiography-guided PCI from inception to August 2023. A random-effects model was used to pool risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) for clinical endpoints. Results Our analysis included 5,139 patients from 11 studies. OCT-guided PCI resulted in a higher minimum stent area (MD = 0.35 [95 % CI, 0.21-0.49]; p < 0.00001), significantly reduced risk of cardiovascular mortality (RR = 0.56 [95 % CI, = 0.32-0.99]; p = 0.04), stent thrombosis (RR = 0.56 [95 % CI, 0.32-0.96]; p = 0.04), stent malapposition RR = 0.79 [95 % CI, 0.71-0.88]; p = < 0.0001) and major edge dissection (RR = 0.47 [95 % CI, 0.34-0.65]; p = <0.00001). However, no statistically significant difference was observed for all-cause mortality (RR = 0.71; p = 0.06), major adverse cardiovascular events (MACE) [RR = 0.80; p = 0.10], myocardial infarction (MI) [RR = 0.84; p = 0.16], target lesion revascularization (TLR) [RR = 0.94; p = 0.68], and target vessel revascularization (TVR) [RR = 0.91; p = 0.52]. Conclusion OCT-guided PCI led to an increased MSA and decreased cardiovascular mortality, stent thrombosis, stent malapposition, and major edge dissection. The incidence of all-cause mortality, MACE, MI, TLR, and TVR remained comparable across the two groups.
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Affiliation(s)
- Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Aimen Shafiq
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Haania Shahbaz
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Priyansha Singh
- Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, Gujarat, India
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Jawad Basit
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
- Cardiovascular Analytics Group, Canterbury, UK
| | | | | | - Shafaqat Ali
- Department of Medicine, Louisiana State University, Shreveport, LA USA
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Wang Y, Yang X, Wu Y, Li Y, Zhou Y. Optical coherence tomography (OCT) - versus angiography-guided strategy for percutaneous coronary intervention: a meta-analysis of randomized trials. BMC Cardiovasc Disord 2024; 24:262. [PMID: 38769510 PMCID: PMC11103981 DOI: 10.1186/s12872-024-03930-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) has been shown to improve procedural outcomes. However, evidence supporting its superiority over angiography-guided PCI in terms of clinical outcomes is still emerging and limited. This study aimed to compare the efficacy and safety of OCT-guided PCI versus angiography-guided PCI in patients with coronary artery disease (CAD). METHODS A systematic search of electronic databases was conducted to identify randomized control trials (RCTs) comparing the clinical outcomes of OCT-guided and angiography-guided PCI in patients with CAD. Clinical endpoints including all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis and major adverse cardiac events (MACE) were assessed. RESULTS Eleven RCTs, comprising 2,699 patients in the OCT-guided group and 2,968 patients in the angiography-guided group met inclusion criteria. OCT-guided PCI was associated with significantly lower rates of cardiovascular death(RR 0.56; 95%CI: 0.32-0.98; p = 0.04; I2 = 0%), stent thrombosis(RR 0.56; 95%CI: 0.33-0.95; p = 0.03; I2 = 0%), and MACE (RR 0.79; 95%CI: 0.66-0.95; p = 0.01; I2 = 5%). The incidence of all-cause death (RR 0.71; 95%CI: 0.49-1.02; p = 0.06; I2 = 0%), myocardial infarction (RR 0.86; 95%CI: 0.67-1.10; p = 0.22; I2 = 0%) and TLR (RR 0.98; 95%CI: 0.73-1.33; p = 0.91; I2 = 0%) was non-significantly lower in the OCT-guided group. CONCLUSIONS Among patients undergoing PCI, OCT-guided PCI was associated with lower incidences of cardiovascular death, stent thrombosis and MACE compared to angiography-guided PCI. TRIAL REGISTRATION PROSPERO registration number: CRD42023484342.
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Affiliation(s)
- Yanwei Wang
- Department of Cardiology, Ningbo Medical Treatment Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China
| | - Xi Yang
- Department of Cardiology, Ningbo Medical Treatment Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China
| | - Yutao Wu
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, PR China
| | - Yanqin Li
- Department of Coronary Care Unit, Ningbo Medical Treatment Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China
| | - Yijiang Zhou
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, PR China.
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Li X, Ge Z, Kan J, Anjum M, Xie P, Chen X, Khan HS, Guo X, Saghir T, Chen J, Gill BUA, Guo N, Sheiban I, Raza A, Wei Y, Chen F, Mintz GS, Zhang JJ, Stone GW, Chen SL. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial. Lancet 2024; 403:1855-1865. [PMID: 38604212 DOI: 10.1016/s0140-6736(24)00282-4] [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: 01/24/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Intravascular ultrasound-guided percutaneous coronary intervention has been shown to result in superior clinical outcomes compared with angiography-guided percutaneous coronary intervention. However, insufficient data are available concerning the advantages of intravascular ultrasound guidance for patients with an acute coronary syndrome. This trial aimed to investigate whether the use of intravascular ultrasound guidance, as compared with angiography guidance, improves the outcomes of percutaneous coronary intervention with contemporary drug-eluting stents in patients presenting with an acute coronary syndrome. METHODS In this two-stage, multicentre, randomised trial, patients aged 18 years or older and presenting with an acute coronary syndrome at 58 centres in China, Italy, Pakistan, and the UK were randomly assigned to intravascular ultrasound-guided percutaneous coronary intervention or angiography-guided percutaneous coronary intervention. Patients, follow-up health-care providers, and assessors were masked to random assignment; however, staff in the catheterisation laboratory were not. The primary endpoint was target vessel failure, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularisation at 1 year after randomisation. This trial is registered at ClinicalTrials.gov, NCT03971500, and is completed. FINDINGS Between Aug 20, 2019 and Oct 27, 2022, 3505 patients with an acute coronary syndrome were randomly assigned to intravascular ultrasound-guided percutaneous coronary intervention (n=1753) or angiography-guided percutaneous coronary intervention (n=1752). 1-year follow-up was completed in 3504 (>99·9%) patients. The primary endpoint occurred in 70 patients in the intravascular ultrasound group and 128 patients in the angiography group (Kaplan-Meier rate 4·0% vs 7·3%; hazard ratio 0·55 [95% CI 0·41-0·74]; p=0·0001), driven by reductions in target vessel myocardial infarction or target vessel revascularisation. There were no significant differences in all-cause death or stent thrombosis between groups. Safety endpoints were also similar in the two groups. INTERPRETATION In patients with an acute coronary syndrome, intravascular ultrasound-guided implantation of contemporary drug-eluting stents resulted in a lower 1-year rate of the composite outcome of cardiac death, target vessel myocardial infarction, or clinically driven revascularisation compared with angiography guidance alone. FUNDING The Chinese Society of Cardiology, the National Natural Scientific Foundation of China, and Jiangsu Provincial & Nanjing Municipal Clinical Trial Project. TRANSLATION For the Mandarin translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Xiaobo Li
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Ping Xie
- Gansu Provincial People's Hospital, Lanzhou, China
| | - Xiang Chen
- Xiamen Heart Center, Xiamen University, Xiamen, China
| | | | - Xiaomei Guo
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases of Pakistan, Karachi, Pakistan
| | - Jing Chen
- People's Hospital of Wuhan University, Wuhan, China
| | | | - Ning Guo
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Imad Sheiban
- Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Afsar Raza
- Airdale General Hospital of the United Kingdom, West Yorkshire, UK
| | - Yongyue Wei
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Feng Chen
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Gary S Mintz
- Cardiovascular Research Foundation at New York, New York, NY, USA
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Giacoppo D, Laudani C, Occhipinti G, Spagnolo M, Greco A, Rochira C, Agnello F, Landolina D, Mauro MS, Finocchiaro S, Mazzone PM, Ammirabile N, Imbesi A, Raffo C, Buccheri S, Capodanno D. Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis. Circulation 2024; 149:1065-1086. [PMID: 38344859 PMCID: PMC10980178 DOI: 10.1161/circulationaha.123.067583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND Results from multiple randomized clinical trials comparing outcomes after intravascular ultrasound (IVUS)- and optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with invasive coronary angiography (ICA)-guided PCI as well as a pivotal trial comparing the 2 intravascular imaging (IVI) techniques have provided mixed results. METHODS Major electronic databases were searched to identify eligible trials evaluating at least 2 PCI guidance strategies among ICA, IVUS, and OCT. The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events. Frequentist random-effects network meta-analyses were conducted. The results were replicated by Bayesian random-effects models. Pairwise meta-analyses of the direct components, multiple sensitivity analyses, and pairwise meta-analyses IVI versus ICA were supplemented. RESULTS The results from 24 randomized trials (15 489 patients: IVUS versus ICA, 46.4%, 7189 patients; OCT versus ICA, 32.1%, 4976 patients; OCT versus IVUS, 21.4%, 3324 patients) were included in the network meta-analyses. IVUS was associated with reduced target lesion revascularization compared with ICA (odds ratio [OR], 0.69 [95% CI, 0.54-0.87]), whereas no significant differences were observed between OCT and ICA (OR, 0.83 [95% CI, 0.63-1.09]) and OCT and IVUS (OR, 1.21 [95% CI, 0.88-1.66]). Myocardial infarction did not significantly differ between guidance strategies (IVUS versus ICA: OR, 0.91 [95% CI, 0.70-1.19]; OCT versus ICA: OR, 0.87 [95% CI, 0.68-1.11]; OCT versus IVUS: OR, 0.96 [95% CI, 0.69-1.33]). These results were consistent with the secondary outcomes of ischemia-driven target lesion revascularization, target vessel myocardial infarction, and target vessel revascularization, and sensitivity analyses generally did not reveal inconsistency. OCT was associated with a significant reduction of stent thrombosis compared with ICA (OR, 0.49 [95% CI, 0.26-0.92]) but only in the frequentist analysis. Similarly, the results in terms of survival between IVUS or OCT and ICA were uncertain across analyses. A total of 25 randomized trials (17 128 patients) were included in the pairwise meta-analyses IVI versus ICA where IVI guidance was associated with reduced target lesion revascularization, cardiac death, and stent thrombosis. CONCLUSIONS IVI-guided PCI was associated with a reduction in ischemia-driven target lesion revascularization compared with ICA-guided PCI, with the difference most evident for IVUS. In contrast, no significant differences in myocardial infarction were observed between guidance strategies.
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Affiliation(s)
- Daniele Giacoppo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Federica Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Davide Landolina
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Antonino Imbesi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Carmelo Raffo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Sergio Buccheri
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, 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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Attar A, Hosseinpour A, Azami P, Kohansal E, Javaheri R. Clinical outcomes of optical coherence tomography versus conventional angiography guided percutaneous coronary intervention: A meta-analysis. Curr Probl Cardiol 2024; 49:102224. [PMID: 38040219 DOI: 10.1016/j.cpcardiol.2023.102224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Performing optical coherence tomography (OCT) as a guide for percutaneous coronary intervention (PCI) compared to conventional coronary angiography has been the subject of the recent cohorts and randomized trials. However, clear evidence demonstrating its superiority is still controversial. METHODS We performed a thorough search in digital databases to find the relevant observational studies and randomized trials comparing OCT and angiography in patients undergoing PCI. A random-effects meta-analysis was undertaken comparing clinical outcomes to generate an odds ratio (OR) with a corresponding 95% confidence interval (CI). Subgroup analyzes were performed based on study design, underlying cardiac condition, and complexity of cases. RESULTS A total of 21 studies (10 RCTs and 11 observational studies) with 11,163 participants (5319: OCT and 5844: angiography group) were included for quantitative synthesis. Performing OCT was associated with lower odds of all-cause (OR (95% CI) = 0.56 (0.48; 0.67)) and cardiac mortality (OR (95% CI) = 0.47 (0.35; 0.63)), major adverse cardiovascular events (OR (95% CI) = 0.60 (0.48; 0.76)), myocardial infarction (OR (95% CI) = 0.79 (0.64; 0.97)), and stent thrombosis (OR (95% CI) = 0.61 (0.39; 0.96)) compared to the angiography group. Other clinical outcomes were similar between the studied groups. The outperformance of OCT was more evident in observational studies and the ones with PCI on complex lesions. CONCLUSION Performing OCT prior to PCI is associated with better clinical outcomes compared to angiography alone based on contemporary evidence. Future well-designed randomized trials are needed to confirm the findings of this meta-analysis.
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Affiliation(s)
- Armin Attar
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Hosseinpour
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Pouria Azami
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rojan Javaheri
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Moreno R, Baptista SB, Valencia J, Gomez-Menchero A, Bouisset F, Ruiz-Arroyo JR, Bento A, Besutti M, Jimenez-Valero S, Rivero-Santana B, Olhmann P, Santos M, Vaquerizo B, Cuissetm T, Lemoine J, Pinar E, Fiarresga A, Urbano C, Marliere S, Braga C, Amat-Santos I, Morgado G, Sarnago F, Telleria M, Van Belle E, Díaz-Fernandez J, Borrego JC, Amabile N, Meneveau N. OPTImized coronary interventions eXplaIn the bEst cliNical outcomEs (OPTI-XIENCE) study. Rationale and study design. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:93-98. [PMID: 37723011 DOI: 10.1016/j.carrev.2023.08.011] [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: 07/22/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Clinical events may occur after percutaneous coronary intervention (PCI), particularly in complex lesions and complex patients. The optimization of PCI result, using pressure guidewire and intracoronary imaging techniques, may reduce the risk of these events. The hypothesis of the present study is that the clinical outcome of patients with indication of PCI and coronary stent implantation that are at high risk of events can be improved with an unrestricted use of intracoronary tools that allow PCI optimization. METHODS AND ANALYSIS Observational prospective multicenter international study, with a follow-up of 12 months, including 1064 patients treated with a cobalt‑chromium everolimus-eluting stent. Inclusion criteria include any of the following: Lesion length > 28 mm; Reference vessel diameter < 2.5 mm or > 4.25 mm; Chronic total occlusion; Bifurcation with side branch ≥2.0 mm;Ostial lesion; Left main lesion; In-stent restenosis; >2 lesions stented in the same vessel; Treatment of >2 vessels; Acute myocardial infarction; Renal insufficiency; Left ventricular ejection fraction <30 %; Staged procedure. The control group will be comprised by a similar number of matched patients included in the "extended risk" cohort of the XIENCE V USA study. The primary endpoint will be the 1-year rate of target lesion failure (TLF) (composite of ischemia-driven TLR, myocardial infarction (MI) related to the target vessel, or cardiac death related to the target vessel). Secondary endpoints will include overall mortality, cardiovascular mortality, acute myocardial infarction, TVR, TLR, target vessel failure, and definitive or probable stent thrombosis at 1 year. IMPLICATIONS The ongoing OPTI-XIENCE study will contribute to the growing evidence supporting the use of intra-coronary imaging techniques for stent optimization in patients with complex coronary lesions.
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Affiliation(s)
- Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | - Patrick Olhmann
- Centres Hospitaliers et Universitaires of Strasbourg, France
| | - Miguel Santos
- Professor Doutor Fernando Fonseca Hospital, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Van Belle
- Centre Hospitalier Regional Universitaire de Lille, France
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Yonetsu T, Jang IK. Cardiac Optical Coherence Tomography: History, Current Status, and Perspective. JACC. ASIA 2024; 4:89-107. [PMID: 38371282 PMCID: PMC10866736 DOI: 10.1016/j.jacasi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 02/20/2024]
Abstract
For more than 2 decades since the first imaging procedure was performed in a living patient, intravascular optical coherence tomography (OCT), with its unprecedented image resolution, has made significant contributions to cardiovascular medicine in the realms of vascular biology research and percutaneous coronary intervention. OCT has contributed to a better understanding of vascular biology by providing insights into the pathobiology of atherosclerosis, including plaque phenotypes and the underlying mechanisms of acute coronary syndromes such as plaque erosion, neoatherosclerosis, stent thrombosis, and myocardial infarction with nonobstructive coronary arteries. Moreover, OCT has been used as an adjunctive imaging tool to angiography for the guidance of percutaneous coronary intervention procedures to optimize outcomes. However, broader application of OCT has faced challenges, including subjective interpretation of the images and insufficient clinical outcome data. Future developments including artificial intelligence-assisted interpretation, multimodality catheters, and micro-OCT, as well as large prospective outcome studies could broaden the impact of OCT on cardiovascular medicine.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Sreenivasan J, Reddy RK, Jamil Y, Malik A, Chamie D, Howard JP, Nanna MG, Mintz GS, Maehara A, Ali ZA, Moses JW, Chen S, Chieffo A, Colombo A, Leon MB, Lansky AJ, Ahmad Y. Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Trials. J Am Heart Assoc 2024; 13:e031111. [PMID: 38214263 PMCID: PMC10926835 DOI: 10.1161/jaha.123.031111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study-level meta-analysis comparing intravascular imaging to angiography to guide PCI was performed. This study aimed to evaluate the clinical outcomes of intravascular imaging-guided PCI compared with angiography-guided PCI. METHODS AND RESULTS A random-effects meta-analysis was performed on the basis of the intention-to-treat principle. The primary outcomes were major adverse cardiac events, cardiac death, and all-cause death. Mixed-effects meta-regression was performed to investigate the impact of complex PCI on the primary outcomes. A total of 16 trials with 7814 patients were included. The weighted mean follow-up duration was 28.8 months. Intravascular imaging led to a lower risk of major adverse cardiac events (relative risk [RR], 0.67 [95% CI, 0.55-0.82]; P<0.001), cardiac death (RR, 0.49 [95% CI, 0.34-0.71]; P<0.001), stent thrombosis (RR, 0.63 [95% CI, 0.40-0.99]; P=0.046), target-lesion revascularization (RR, 0.67 [95% CI, 0.49-0.91]; P=0.01), and target-vessel revascularization (RR, 0.60 [95% CI, 0.45-0.80]; P<0.001). In complex lesion subsets, the point estimate for imaging-guided PCI compared with angiography-guided PCI for all-cause death was a RR of 0.75 (95% CI, 0.55-1.02; P=0.07). CONCLUSIONS In patients undergoing PCI, intravascular imaging is associated with reductions in major adverse cardiac events, cardiac death, stent thrombosis, target-lesion revascularization, and target-vessel revascularization. The magnitude of benefit is large and consistent across all included studies. There may also be benefits in all-cause death, particularly in complex lesion subsets. These results support the use of intravascular imaging as standard of care and updates of clinical guidelines.
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Affiliation(s)
| | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
| | - Yasser Jamil
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | - Aaqib Malik
- Department of CardiologyWestchester Medical Center, New York Medical CollegeValhallaNYUSA
| | - Daniel Chamie
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | - James P. Howard
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
| | - Michael G. Nanna
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | | | - Akiko Maehara
- Cardiovascular Research FoundationNew YorkNYUSA
- Columbia University Medical CenterNew YorkNYUSA
| | - Ziad A. Ali
- Cardiovascular Research FoundationNew YorkNYUSA
- St Francis HospitalRoslynNYUSA
| | - Jeffrey W. Moses
- Cardiovascular Research FoundationNew YorkNYUSA
- Columbia University Medical CenterNew YorkNYUSA
- St Francis HospitalRoslynNYUSA
| | - Shao‐Liang Chen
- Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Alaide Chieffo
- Vita Salute San Raffaele UniversityMilanItaly
- IRCCS San Raffaele Scientific InstituteMilanItaly
| | | | - Martin B. Leon
- Cardiovascular Research FoundationNew YorkNYUSA
- Columbia University Medical CenterNew YorkNYUSA
| | - Alexandra J. Lansky
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | - Yousif Ahmad
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
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10
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Romagnoli E, Burzotta F, Vergallo R, Gatto L, Biondi-Zoccai G, Ramazzotti V, Biccirè F, Budassi S, Trani C, Ali Z, Stone GW, Prati F. Clinical impact of OCT-derived suboptimal stent implantation parameters and definitions. Eur Heart J Cardiovasc Imaging 2023; 25:48-57. [PMID: 37463223 PMCID: PMC10735315 DOI: 10.1093/ehjci/jead172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/09/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Despite growing evidence supporting the clinical utility of optical coherence tomography (OCT) guidance during percutaneous coronary interventions (PCIs), there is no common agreement as to the optimal stent implantation parameters that enhance clinical outcome. METHODS AND RESULTS We retrospectively examined the predictive accuracy of suboptimal stent implantation definitions proposed from the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies for the long-term risk of device-oriented cardiovascular events (DoCE) in the population of large all-comers CLI-OPCI project. A total of 1020 patients undergoing OCT-guided drug-eluting stent implantation in the CLI-OPCI registry with a median follow-up of 809 (quartiles 414-1376) days constituted the study population. According to CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA criteria, the incidence of suboptimal stent implantation was 31.8%, 58.1%, and 57.8%, respectively. By multivariable Cox analysis, suboptimal stent implantation criteria from the CLI-OPCI II [hazard ratio 2.75 (95% confidence interval 1.88-4.02), P < 0.001] and ILUMIEN-IV OPTIMAL PCI [1.79 (1.18-2.71), P = 0.006] studies, but not FORZA trial [1.11 (0.75-1.63), P = 0.597], were predictive of DoCE. At long-term follow-up, stent edge disease with minimum lumen area <4.5 mm2 [8.17 (5.32-12.53), P < 0.001], stent edge dissection [2.38 (1.33-4.27), P = 0.004], and minimum stent area <4.5 mm2 [1.68 (1.13-2.51), P = 0.011] were the main OCT predictors of DoCE. CONCLUSION The clinical utility of OCT-guided PCI might depend on the metrics adopted to define suboptimal stent implantation. Uncovered disease at the stent border, stent edge dissection, and minimum stent area <4.5 mm2 were the strongest OCT associates of stent failure.
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Affiliation(s)
- Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Rocco Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Gatto
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | | | - Flavio Biccirè
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | - Simone Budassi
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | - Carlo Trani
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Ziad Ali
- St Francis Hospital & Heart Center, Roslyn, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- The Icahn School of Medicine at Mount Sinai, Mount Sinai Heart and the Cardiovascular Research Foundation, New York, NY, USA
| | - Francesco Prati
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
- UniCamillus—Saint Camillus International University of Health Sciences, Rome, Italy
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11
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Kuno T, Kiyohara Y, Maehara A, Ueyama HA, Kampaktsis PN, Takagi H, Mehran R, Stone GW, Bhatt DL, Mintz GS, Bangalore S. Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention. J Am Coll Cardiol 2023; 82:2167-2176. [PMID: 37995152 DOI: 10.1016/j.jacc.2023.09.823] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether intravascular imaging guidance or functional guidance is the best strategy to optimize outcomes and if the results are different in patients with vs without acute coronary syndromes (ACS). OBJECTIVES The purpose of this study was to evaluate clinical outcomes with imaging-guided PCI or functionally guided PCI when compared with conventional angiography-guided PCI. METHODS We searched PUBMED and EMBASE for randomized controlled trials investigating outcomes with intravascular imaging-guided, functionally guided, or angiography-guided PCI. The primary outcome from this network meta-analysis was trial-defined major adverse cardiovascular event (MACE)-a composite of cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR). PCI strategies were ranked (best to worst) using P scores. RESULTS Our search identified 32 eligible randomized controlled trials and included a total of 22,684 patients. Compared with angiography-guided PCI, intravascular imaging-guided PCI was associated with reduced risk of MACE (relative risk [RR]: 0.72; 95% CI: 0.62-0.82), cardiovascular death (RR: 0.56; 95% CI: 0.42-0.75), MI (RR: 0.81; 95% CI: 0.66-0.99), stent thrombosis (RR: 0.48; 95% CI: 0.31-0.73), and TLR (RR: 0.75; 95% CI: 0.57-0.99). Similarly, when compared with angiography-guided PCI, functionally guided PCI was associated with reduced risk of MACE and MI. Intravascular imaging-guided PCI ranked first for the outcomes of MACE, cardiovascular death, stent thrombosis, and TLR. The results were consistent in the ACS and non-ACS cohorts. CONCLUSIONS Angiography-guided PCI had consistently worse outcomes compared with intravascular imaging-guided and functionally guided PCI. Intravascular imaging-guided PCI was the best strategy to reduce the risk of cardiovascular events.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yuko Kiyohara
- Department of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Hiroki A Ueyama
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University Grossman School of Medicine, New York, New York, USA.
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12
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Khan SU, Agarwal S, Arshad HB, Akbar UA, Mamas MA, Arora S, Baber U, Goel SS, Kleiman NS, Shah AR. Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis. BMJ 2023; 383:e077848. [PMID: 37973170 PMCID: PMC10652093 DOI: 10.1136/bmj-2023-077848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. STUDY SELECTION Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. MAIN OUTCOME MEASURES Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. RESULTS In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. CONCLUSIONS Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023433568.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Usman Ali Akbar
- Department of Medicine, West Virginia University - Camden Clark Medical Center, Parkersburg, WV, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stroke-On-Trent, UK
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
| | - Shilpkumar Arora
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Usman Baber
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Alpesh R Shah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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13
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Simard T, Jung R, Di Santo P, Sarathy K, Majeed K, Motazedian P, Short S, Dhaliwal S, Labinaz A, Sarma D, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography. J Cardiovasc Transl Res 2023; 16:1194-1204. [PMID: 37227686 DOI: 10.1007/s12265-023-10399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
Percutaneous coronary intervention (PCI) is a management strategy for symptomatic obstructive coronary artery disease (CAD). Despite advancements, in-stent restenosis (ISR) still imparts a 1-2% annual rate of repeat revascularization-a focus of ongoing translational research. Optical coherence tomography (OCT) provides high resolution virtual histology of stents. Our study evaluates the use of OCT for virtual histological assessment of stent healing in a rabbit aorta model, enabling complete assessment of intraluminal healing throughout the stent. ISR varies based on intra-stent location, stent length, and stent type in a rabbit model-important considerations for translational experimental design. Atherosclerosis leads to more prominent ISR proliferation independent of stent-related factors. The rabbit stent model mirrors clinical observations, while OCT-based virtual histology demonstrates utility for pre-clinical stent assessment. Pre-clinical models should incorporate clinical and stent factors as feasible to maximize translation to clinical practice.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Richard Jung
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Kiran Sarathy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Kamran Majeed
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Spencer Short
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Shan Dhaliwal
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Alisha Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
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14
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Nafee T, Shah A, Forsberg M, Zheng J, Ou J. State-of-art review: intravascular imaging in percutaneous coronary interventions. CARDIOLOGY PLUS 2023; 8:227-246. [PMID: 38304487 PMCID: PMC10829907 DOI: 10.1097/cp9.0000000000000069] [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: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
The history of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) reflects the relentless pursuit of innovation in interventional cardiology. These intravascular imaging technologies have played a pivotal role in our understanding of coronary atherosclerosis, vascular pathology, and the interaction of coronary stents with the vessel wall. Two decades of clinical investigations demonstrating the clinical efficacy and safety of intravascular imaging modalities have established these technologies as staples in the contemporary cardiac catheterization lab's toolbox and earning their place in revascularization clinical practice guidelines. In this comprehensive review, we will delve into the historical evolution, mechanisms, and technical aspects of IVUS and OCT. We will discuss the expanding evidence supporting their use in complex percutaneous coronary interventions, emphasizing their crucial roles in optimizing patient outcomes and ensuring procedural success. Furthermore, we will explore the substantial advances that have propelled these imaging modalities to the forefront of contemporary interventional cardiology. Finally, we will survey the latest developments in the field and explore the promising future directions that have the potential to further revolutionize coronary interventions.
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Affiliation(s)
- Tarek Nafee
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Areeb Shah
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Michael Forsberg
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Jingsheng Zheng
- Department of Cardiology, AtlantiCare Regional Medical Center, Pomona, NJ 08240, USA
| | - Jiafu Ou
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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15
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Yonetsu T, Wakabayashi K, Mizukami T, Yamamoto MH, Yasuhara S, Kondo S, Oishi Y, Okabe T, Sugiyama T, Araki M, Takano M, Kobayashi N, Kimura S, Yamakami Y, Suwa S, Nakamura S, Mitomo S, Kakuta T, Usui E, Higuma T, Ako J, Minami Y, Iwasaki M, Shite J, Kozuki A, Saito S, Shishido K, Okura H, Naruse G, Uemura S, Kume T, Nanasato M, Dohi T, Ashikaga T, Otake H, Mori H, Sekimoto T, Sugizaki Y, Shinke T. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Rationale and Design of the ATLAS-OCT Study. Am J Cardiol 2023; 203:466-472. [PMID: 37562073 DOI: 10.1016/j.amjcard.2023.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023]
Abstract
Even after successful revascularization with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), subsequent adverse events still occur. Previous studies have suggested potential benefits of intravascular imaging, including optical coherence tomography (OCT). However, the feasibility of OCT-guided primary PCI has not been systematically examined in these patients. The ATLAS-OCT (ST-elevation Acute myocardial infarcTion and cLinicAl outcomeS treated by Optical Coherence Tomography-guided percutaneous coronary intervention) trial was designed to investigate the feasibility of OCT guidance during primary PCI for STEMI in experienced centers with expertise on OCT-guided PCI as a prospective, multicenter registry of consecutive patients with STEMI who underwent a primary PCI. The sites' inclusion criteria are as follows: (1) acute care hospitals providing 24/7 emergency care for STEMI, and (2) institutions where OCT-guided PCI is the first choice for primary PCI in STEMI. All patients with STEMI who underwent primary PCI at participating sites will be consecutively enrolled, irrespective of OCT use during PCI. The primary end point will be the rate of successful OCT imaging during the primary PCI. As an ancillary imaging modality to angiography, OCT provides morphologic information during PCI for the assessment of plaque phenotypes, vessel sizing, and PCI optimization. Major adverse cardiac events, defined as a composite of all-cause death, myocardial infarction, and target vessel revascularization at 1 year, will also be recorded. The ATLAS-OCT study will clarify the feasibility of OCT-guided primary PCI for patients with STEMI and further identify a suitable patient group for OCT-guided primary PCI.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takuya Mizukami
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Myong Hwa Yamamoto
- Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University, Tokyo, Japan
| | - Sakiko Yasuhara
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshitaka Okabe
- Division of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masamichi Takano
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Yosuke Yamakami
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Hyogo, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Genki Naruse
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Okayama, Japan
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Okayama, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yoichiro Sugizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
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16
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Simard T, Jung R, Di Santo P, Labinaz A, Short S, Motazedian P, Dhaliwal S, Sarma D, Rasheed A, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Dipyridamole and vascular healing following stent implantation. Front Cardiovasc Med 2023; 10:1130304. [PMID: 37745122 PMCID: PMC10514894 DOI: 10.3389/fcvm.2023.1130304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patients undergoing coronary stent implantation incur a 2% annual rate of adverse events, largely driven by in-stent restenosis (ISR) due to neointimal (NI) tissue proliferation, a process in which smooth muscle cell (SMC) biology may play a central role. Dipyridamole (DP) is an approved therapeutic agent with data supporting improved vascular patency rates. Pre-clinical data supports that DP may enact its vasculoprotective effects via adenosine receptor-A2B (ADOR-A2B). We sought to evaluate the efficacy of DP to mitigate ISR in a pre-clinical rabbit stent model. Methods & Results 24 New Zealand White Rabbits were divided into two cohorts-non-atherosclerosis and atherosclerosis (n = 12/cohort, 6 male and 6 female). Following stent implantation, rabbits were randomized 1:1 to control or oral dipyridamole therapy for 6 weeks followed by optical coherence tomography (OCT) and histology assessment of NI burden and stent strut healing. Compared to control, DP demonstrated a 16.6% relative reduction in NI volume (14.7 ± 0.8% vs. 12.5 ± 0.4%, p = 0.03) and a 36.2% relative increase in optimally healed stent struts (37.8 ± 2.8% vs. 54.6 ± 2.5%, p < 0.0001). Atherosclerosis demonstrated attenuated effect with no difference in NI burden (15.2 ± 1.0% vs. 16.9 ± 0.8%, p = 0.22) and only a 14.2% relative increase in strut healing (68.3 ± 4.1% vs. 78.7 ± 2.5%, p = 0.02). DP treated rabbits had a 44.6% (p = 0.045) relative reduction in NI SMC content. In vitro assessment of DP and coronary artery SMCs yielded dose-dependent reduction in SMC migration and proliferation. Selective small molecule antagonism of ADOR-A2B abrogated the effects of DP on SMC proliferation. DP modulated SMC phenotypic switching with ADOR-A2B siRNA knockdown supporting its role in the observed effects. Conclusion Dipyridamole reduces NI proliferation and improves stent healing in a preclinical model of stent implantation with conventional antiplatelets. Atherosclerosis attenuates the observed effect. Clinical trials of DP as an adjunctive agent may be warranted to evaluate for clinical efficacy in stent outcomes.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard Jung
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pietro Di Santo
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alisha Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Spencer Short
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pouya Motazedian
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shan Dhaliwal
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Adil Rasheed
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of BMI, Faculty of Medicine, Ottawa, ON, Canada
| | - F. Daniel Ramirez
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michael Froeschl
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marino Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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17
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Park DY, An S, Jolly N, Attanasio S, Yadav N, Gutierrez JA, Nanna MG, Rao SV, Vij A. Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography-guided percutaneous coronary interventions: A systematic review, network meta-analysis, and meta-regression. Catheter Cardiovasc Interv 2023; 102:440-450. [PMID: 37483068 PMCID: PMC10908343 DOI: 10.1002/ccd.30784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/02/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on coronary angiography (CA) and have shown to improve clinical outcomes. We sought to compare the clinical efficacy of IVUS, OCT, and conventional CA-guided percutaneous coronary interventions (PCI). METHODS Frequentist and Bayesian network meta-analyses of randomized clinical trials were performed to compare clinical outcomes of PCI performed with IVUS, OCT, or CA alone. RESULTS A total of 28 trials comprising 12,895 patients were included. IVUS when compared with CA alone was associated with a significantly reduced risk of major adverse cardiovascular events (MACE) (risk ratio: [RR] 0.74, 95% confidence interval: [CI] 0.63-0.88), cardiac death (RR: 0.64, 95% CI: 0.43-0.94), target lesion revascularization (RR: 0.68, 95% CI: 0.57-0.80), and target vessel revascularization (RR: 0.64, 95% CI: 0.50-0.81). No differences in comparative clinical efficacy were found between IVUS and OCT. Rank probability analysis bestowed the highest probability to IVUS in ranking as the best imaging modality for all studied outcomes except for all-cause mortality. CONCLUSION Compared with CA, the use of IVUS in PCI guidance provides significant benefit in reducing MACE, cardiac death, and revascularization. OCT had similar outcomes to IVUS, but more dedicated studies are needed to confirm the superiority of OCT over CA.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Seokyung An
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Neeraj Jolly
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Steve Attanasio
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Neha Yadav
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | | | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sunil V. Rao
- NYU Langone Health System, New York, New York, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
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18
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Andreasen LN, Christiansen EH, Mogensen LJH, Holm NR. Comparison of definitions of coronary artery reference sizes and effects on stent selection and evaluation of stent expansion. Int J Cardiovasc Imaging 2023; 39:1825-1837. [PMID: 37405610 PMCID: PMC10520108 DOI: 10.1007/s10554-023-02890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023]
Abstract
Accurate determination of coronary reference size is essential for optimal stent selection and evaluation of stent expansion during percutaneous coronary intervention (PCI). Several approaches for reference size estimation have been published with no universal agreement. The aim of this study was to investigate if potential differences in coronary reference size estimation lead to differences in stent and balloon selection and in detection of stent under expansion. Definitions for coronary reference size estimation, stent size selection, and stent expansion were identified in 17 randomized controlled trials. The identified methods were applied in a population of 32 clinical cases. Reference size estimates ranged up to 1.35mm, and indicated nominal stent size ranged up to 1.0 mm in the same case depending on method. Mean relative stent expansion ranged from 54±12% to mean 100±29% depending on the applied reference method. Choice of method for reference size estimation using intravascular imaging may influence stent selection and greatly affects evaluation of post-PCI stent expansion.
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Affiliation(s)
- Lene Nyhus Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
- Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark.
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19
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Kadavil RM, Abdullakutty J, Patel T, Rathnavel S, Singh B, Chouhan NS, Malik FTN, Hiremath S, Gunasekaran S, Kalarickal SM, Kumar V, Subban V. Impact of real-time optical coherence tomography and angiographic coregistration on the percutaneous coronary intervention strategy. ASIAINTERVENTION 2023; 9:124-132. [PMID: 37736205 PMCID: PMC10507610 DOI: 10.4244/aij-d-22-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/13/2023] [Indexed: 09/23/2023]
Abstract
Background The use of optical coherence tomography (OCT) with angiographic coregistration (ACR) during percutaneous coronary intervention (PCI) for procedural decision-making is evolving; however, large-scale data in real-world practice are lacking. Aims Our study aims to evaluate the real-time impact of OCT-ACR on clinician decision-making during PCI. Methods Patients with angiographic diameter stenosis >70% in at least one native coronary artery were enrolled in the study. The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR. Results A total of 500 patients were enrolled in the study between November 2018 and March 2020. Among these, data related to 472 patients with 483 lesions were considered for analysis. Preprocedural OCT resulted in a change in PCI strategy in 80% of lesions: lesion preparation (25%), stent length (53%), stent diameter (36%), and device landing zone (61%). ACR additionally impacted the treatment strategy in 34% of lesions. Postprocedural OCT demonstrated underexpansion (15%), malapposition (14%), and tissue/thrombus prolapse (7%), thereby requiring further interventions in 30% of lesions. No further change in strategy was observed with subsequent postprocedural ACR. Angiographic and procedural success was achieved in 100% of patients, and the overall incidence of major adverse cardiovascular events at 1 year was 0.85%. Conclusions The outcomes reflect the real-time impact of OCT-ACR on the overall procedural strategy in patients undergoing PCI. ACR had a significant impact on the treatment strategy and was associated with better clinical outcomes at 1 year after index PCI. OCT-ACR has become a practical tool for improving outcomes in patients with complex lesions.
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Affiliation(s)
| | | | | | - Sivakumar Rathnavel
- Department of Cardiology, Meenakshi Mission Hospital and Research Centre, Madurai, India
| | - Balbir Singh
- Department of Interventional Cardiology, Medanta-Heart Institute, New Delhi, India
| | | | - Fazila Tun Nesa Malik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | | | | | | | - Viveka Kumar
- Department of Cardiology, Max Super Speciality Hospital, Saket, India
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20
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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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21
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Şaylık F, Hayıroglu Mİ, Akbulut T, Çınar T. Comparison of Long-Term Outcomes Between Intravascular Ultrasound-, Optical Coherence Tomography- and Angiography-Guided Stent Implantation: A Meta-Analysis. Angiology 2023:33197231198674. [PMID: 37644871 DOI: 10.1177/00033197231198674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided percutaneous coronary interventions (PCI) are alternative techniques to angiography-guided (ANG-g) PCI in patients with coronary artery disease (CAD), especially for optimal stent deployment in coronary arteries. We conducted a network meta-analysis including studies comparing those three techniques. We searched databases for studies that compared IVUS, OCT, and ANG-g PCI in patients with CAD. Overall, 52 studies with 231,137 patients were included in this meta-analysis. ANG-g PCI had higher major adverse cardiovascular events (MACEs), all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) than IVUS-guided PCI. Of note, both OCT-guided and IVUS-guided PCI had similar outcomes. The frequency of MACEs, cardiac death, and MI were higher in ANG-g PCI than in OCT-guided PCI. The highest benefit was established with OCT for MACEs (P-score=.973), MI (P-score=.823), and cardiac death (P-score=.921) and with IVUS for all-cause death (P-score=.792), TLR (P -score=.865), and ST (P-score=.930). This network meta-analysis indicated that using OCT or IVUS for optimal stent implantation provides better outcomes in comparison with ANG-g in patients with CAD undergoing PCI.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Mert İlker Hayıroglu
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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22
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Macherey-Meyer S, Meertens MM, Heyne S, Braumann S, Tichelbäcker T, Wienemann H, Mauri V, Baldus S, Adler C, Lee S. Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndrome: a meta-analysis. Clin Res Cardiol 2023:10.1007/s00392-023-02272-7. [PMID: 37524839 DOI: 10.1007/s00392-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is standard of care in patients with acute coronary syndrome (ACS) suitable for interventional revascularization. Intracoronary imaging by optical coherence tomography (OCT) expanded treatment approaches adding diagnostic information and contributing to stent optimization. OBJECTIVES This meta-analysis aimed to assess the effects of OCT-guided vs. angiography-guided PCI in treatment of ACS. METHODS A structured literature search was performed. All controlled trials evaluating OCT-guided vs. angiography-guided PCI in patients with ACS were eligible. The primary end point was major adverse cardiac events (MACE). RESULTS Eight studies enrolling 2612 patients with ACS were eligible. 1263 patients underwent OCT-guided and 1,349 patients angiography-guided PCI. OCT guidance was associated with a 30% lower likelihood of MACE (OR 0.70, 95% CI 0.53-0.93, p = 0.01, I2 = 1%). OCT-guided PCI was also associated with significantly decreased cardiac mortality (OR 0.49, 95% CI 0.25-0.96, p = 0.04, I2 = 0%). There was no detectable difference in all-cause mortality (OR 1.08, 95% CI 0.51-2.31, p = 0.83, I2 = 0). Patients in OCT-guided group less frequently required target lesion revascularization (OR 0.26, 95% CI 0.07-0.95, p = 0.04, I2 = 0%). Analysis of myocardial infarction did not result in significant treatment differences. In subgroup or sensitivity analysis the observed advantages of OCT-guided PCI were not replicable. CONCLUSION The evidence suggests that PCI guidance with OCT in ACS decreases MACE, cardiac death and target lesion revascularization compared to angiography. On individual study level, in subgroup or sensitivity analyses these advantages were not thoroughly replicable.
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Affiliation(s)
- S Macherey-Meyer
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - M M Meertens
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - S Heyne
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - S Braumann
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - T Tichelbäcker
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - H Wienemann
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - V Mauri
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - S Baldus
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - C Adler
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - S Lee
- Faculty of Medicine, Clinic III for Internal Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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23
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Yamamoto K, Shiomi H, Morimoto T, Miyazawa A, Watanabe H, Natsuaki M, Watanabe H, Yamaji K, Ohya M, Nakamura S, Mitomo S, Suwa S, Domei T, Tatsushima S, Ono K, Sakamoto H, Shimamura K, Shigetoshi M, Taniguchi R, Nishimoto Y, Okayama H, Matsuda K, Yokomatsu T, Muto M, Kawaguchi R, Kishi K, Hadase M, Fujita T, Nishida Y, Nishino M, Otake H, Suematsu N, Ajimi T, Tanabe K, Abe M, Hibi K, Kadota K, Ando K, Kimura T. Target Lesion Revascularization After Intravascular Ultrasound-Guided Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2023; 16:e012922. [PMID: 37192307 DOI: 10.1161/circinterventions.123.012922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/05/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Several stent expansion criteria derived from the intravascular ultrasound (IVUS) evaluation have been proposed to predict future clinical outcomes, but optimal stent expansion criteria as a guide during percutaneous coronary intervention (PCI) are still controversial. There are no studies evaluating the utility of stent expansion criteria along with the clinical and procedural factors in predicting target lesion revascularization (TLR) after contemporary IVUS-guided PCI. METHODS OPTIVUS-Complex PCI study (Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention) multivessel cohort was a prospective multicenter study enrolling 961 patients undergoing multivessel PCI including left anterior descending coronary artery using IVUS with an intention to meet the prespecified criteria for optimal stent expansion. We compared several stent expansion criteria (minimum stent area [MSA], MSA/distal or average reference lumen area, MSA/distal or average reference vessel area, OPTIVUS criteria, IVUS-XPL [Impact of Intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions] criteria, ULTIMATE [Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions] criteria, and modified MUSIC [Multicenter Ultrasound Stenting in Coronaries Study] criteria) as well as clinical, angiographic, and procedural characteristics between lesions with and without TLR. RESULTS Among 1957 lesions, the cumulative 1-year incidence of lesion-based TLR was 1.6% (30 lesions). Hemodialysis, treatment of proximal left anterior descending coronary artery lesions, calcified lesions, small proximal reference lumen area, and small MSA had univariate associations with TLR, while all of the stent expansion criteria except for MSA were not associated with TLR. The independent risk factors of TLR were calcified lesions (hazard ratio, 2.34 [95% CI, 1.03-5.32]; P=0.04) and small proximal reference lumen area (Tertile 1: hazard ratio, 7.01 [95% CI, 1.45-33.93]; P=0.02; and Tertile 2: hazard ratio, 5.40 [95% CI, 1.17-24.90]; P=0.03). CONCLUSIONS In contemporary IVUS-guided PCI practice, the 1-year incidence of TLR was very low. MSA, but not other stent expansion criteria, had univariate association with TLR. Independent risk factors of TLR were calcified lesions and small proximal reference lumen area, although the findings should be interpreted with caution due to small number of TLR events, limited lesion complexity, and short duration of follow-up.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.)
| | | | - Hiroki Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Japan (H.W., S.T.)
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Saga University, Japan (M.N.)
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (S.N., S.M.)
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (S.N., S.M.)
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan (S.S.)
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (T.D., K.A.)
| | - Shojiro Tatsushima
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Japan (H.W., S.T.)
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Japan (H.S., K.S.)
| | | | - Masataka Shigetoshi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan (M.S.)
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (R.T., Y.N.)
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (R.T., Y.N.)
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan (H.O., K.M.)
| | - Kensho Matsuda
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan (H.O., K.M.)
| | | | - Masahiro Muto
- Department of Cardiology, Hamamatsu Medical Center, Japan (M.M.)
| | - Ren Kawaguchi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (R.K.)
| | - Koichi Kishi
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
- Department of Cardiology, Tokushima Red Cross Hospital, Japan (K.K.)
| | - Mitsuyoshi Hadase
- Department of Cardiology, Saiseikai Shiga Hospital, Ritto, Japan (M.H.)
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Japan (T.F.)
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan (Y.N.)
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan (M.N.)
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan (H.O.)
| | - Nobuhiro Suematsu
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Japan (N.S., T.A.)
| | - Tsuneki Ajimi
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Japan (N.S., T.A.)
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (K.T.)
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan (M.A.)
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H.)
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (T.D., K.A.)
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
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24
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Andreasen LN, Balleby IR, Barkholt TØ, Hebsgaard L, Terkelsen CJ, Holck EN, Jensen LO, Maeng M, Dijkstra J, Antonsen L, Kristensen SD, Tu S, Lassen JF, Christiansen EH, Holm NR. Early healing after treatment of coronary lesions by thin strut everolimus, or thicker strut biolimus eluting bioabsorbable polymer stents: The SORT-OUT VIII OCT study. Catheter Cardiovasc Interv 2023; 101:787-797. [PMID: 36740229 DOI: 10.1002/ccd.30579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
AIMS Early healing after drug-eluting stent (DES) implantation may reduce the risk of stent thrombosis. The aim of this study was to compare patterns of early healing after implantation of the thin strut everolimus-eluting Synergy DES (Boston Scientific) or the biolimus-eluting Biomatix Neoflex DES (Biosensors). METHODS AND RESULTS A total of 160 patients with the chronic or acute coronary syndrome were randomized 1:1 to Synergy or Biomatrix DES. Optical coherence tomography (OCT) was performed at baseline and at either 1- or 3-month follow-up. The primary endpoint was a coronary stent healing index (CSHI), a weighted index of strut coverage, neointimal hyperplasia, malapposition, and extrastent lumen. A total of 133 cases had OCT follow-up and 119 qualified for matched OCT analysis. The median CSHI score did neither differ significantly between the groups at 1 month: Synergy 8.0 (interquartile range [IQR]: 3.0; 14.0) versus Biomatrix 8.5 (IQR: 4.0; 15.0) (p = 0.47) nor at 3 months: Synergy 6.5 (IQR: 2.0; 13.0) versus Biomatrix 6.0 (IQR: 4.0; 11.0) (p = 0.83). Strut coverage was 84.6% (IQR: 72.0; 97.9) for Synergy versus 77.6% (IQR: 70.1; 90.3) for Biomatrix (p = 0.15) at 1 month and 90.3% (IQR 79.0; 98.8) (Synergy) versus 83.9% (IQR: 77.5; 92.6) (Biomatrix) (p = 0.068) at 3 months. Pooled 1- and 3-month coverage was 88.6% (IQR: 74.4; 98.4) for Synergy compared with 80.7% (IQR: 73.2; 90.8) for Biomatrix (p = 0.02). CONCLUSIONS The early healing response after treatment with the Synergy or Biomatrix DES did not differ significantly as determined by a healing index. The Synergy DES showed overall better early stent strut coverage.
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Affiliation(s)
- Lene N Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida R Balleby
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Hebsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jouke Dijkstra
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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25
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Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:590-605. [PMID: 36754518 DOI: 10.1016/j.jacc.2022.11.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/09/2023]
Abstract
Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and further studies evaluating broader use are underway or in development. This paper provides an overview of currently available IVI technologies, reviews data supporting their utilization for PCI guidance and optimization across a variety of lesion subsets, proposes best practices, and advocates for broader use of these technologies as a part of contemporary practice.
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26
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Volleberg R, Mol JQ, van der Heijden D, Meuwissen M, van Leeuwen M, Escaned J, Holm N, Adriaenssens T, van Geuns RJ, Tu S, Crea F, Stone G, van Royen N. Optical coherence tomography and coronary revascularization: from indication to procedural optimization. Trends Cardiovasc Med 2023; 33:92-106. [PMID: 34728349 DOI: 10.1016/j.tcm.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023]
Abstract
Angiography alone is the most commonly used imaging modality for guidance of percutaneous coronary interventions. Angiography is limited, however, by several factors, including that it only portrays a low resolution, two-dimensional outline of the lumen and does not inform on plaque composition and functional stenosis severity. Optical coherence tomography (OCT) is an intracoronary imaging technique that has superior spatial resolution compared to all other imaging modalities. High-resolution imaging of the vascular wall enables precise measurement of vessel wall and luminal dimensions, more accurately informing about the anatomic severity of epicardial stenoses, and also provides input for computational models to assess functional severity. The very high-resolution images also permit plaque characterization that may be informative for prognostication. Moreover, periprocedural imaging provides valuable information to guide lesion preparation, stent implantation and to evaluate acute stent complications for which iterative treatment might reduce the occurrence of major adverse stent events. As such, OCT represent a potential future all-in-one tool that provides the data necessary to establish the indications, procedural planning and optimization, and final evaluation of percutaneous coronary revascularization.
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Affiliation(s)
- Rick Volleberg
- Department of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - Jan-Quinten Mol
- Department of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - Dirk van der Heijden
- Department of Cardiology, Haaglanden Medisch Centrum, the Hague, the Netherlands
| | | | | | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos El Instituto de Investigación Sanitaria del Hospital Clinic San Carlos and Universidad Complutense de Madrid, Madrid, Spain
| | - Niels Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | | | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome Italy
| | - Gregg Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Niels van Royen
- Department of Cardiology, Radboudumc, Nijmegen, the Netherlands.
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27
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Saad M, Seoudy H, Frank D. Editorial commentary: Optical coherence tomography: What we still need to know. Trends Cardiovasc Med 2023; 33:107-108. [PMID: 34801664 DOI: 10.1016/j.tcm.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany.
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28
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Kalzifizierte Stenosen richtig behandeln. Herz 2022; 47:503-512. [DOI: 10.1007/s00059-022-05144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
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29
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Siddiqi TJ, Khan MS, Karimi Galougahi K, Shlofmitz E, Moses JW, Rao S, West NEJ, Wolff E, Hochler J, Chau K, Khalique O, Shlofmitz RA, Jeremias A, Ali ZA. Optical coherence tomography versus angiography and intravascular ultrasound to guide coronary stent implantation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S44-S56. [PMID: 36251325 DOI: 10.1002/ccd.30416] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is an adjunct to angiography-guided coronary stent placement. However, in the absence of dedicated, appropriately powered randomized controlled trials, the impact of OCT on clinical outcomes is unclear. OBJECTIVE To conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus angiography-guided and intravascular ultrasound (IVUS)-guided coronary stent implantation. METHODS MEDLINE and Cochrane Central were queried from their inception through July 2022 for all studies that sought to compare OCT-guided percutaneous coronary intervention (PCI) to angiography-guided and IVUS-guided PCI. The primary endpoint was minimal stent area (MSA) compared between modalities. Clinical endpoints of interest were all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis (ST). Risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS Thirteen studies (8 randomized control trials and 5 observational studies) enrolling 6312 participants were included. OCT was associated with a strong trend toward increased MSA compared to angiography (MD = 0.36, p = 0.06). OCT-guided PCI was also associated with a reduction in the incidence of all-cause mortality [RR = 0.59, 95% CI (0.35, 0.97), p = 0.04] and cardiovascular mortality [RR = 0.41, 95% CI (0.21, 0.80), p = 0.009] compared with angiography-guided PCI. Point estimates favored OCT relative to angiography in MACE [RR = 0.75, 95% CI (0.47, 1.20), p = 0.22] and MI [RR = 0.75, 95% CI (0.53, 1.07), p = 0.12]. No differences were detected in ST [RR = 0.71, 95% CI (0.21, 2.44), p = 0.58], TLR [RR = 0.71, 95% CI (0.17, 3.05), p = 0.65], or TVR rates [RR = 0.89, 95% CI (0.46, 1.73), p = 0.73]. Compared with IVUS guidance, OCT guidance was associated with a nonsignificant reduction in the MSA (MD = -0.16, p = 0.27). The rates of all-cause and cardiovascular mortality, MACE, MI, TLR, TVR, or ST were similar between OCT-guided and IVUS-guided PCI. CONCLUSIONS OCT-guided PCI was associated with reduced all-cause and cardiovascular mortality compared to angiography-guided PCI. These results should be considered hypothesis generating as the mechanisms for the improved outcomes were unclear as no differences were detected in the rates of TLR, TVR, or ST. OCT- and IVUS-guided PCI resulted in similar post-PCI outcomes.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Raleigh-Durham, North Carolina, USA
| | - Keyvan Karimi Galougahi
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Jeffrey W Moses
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Sunil Rao
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Raleigh-Durham, North Carolina, USA
| | | | - Eric Wolff
- St. Francis Hospital, Roslyn, New York, USA
| | | | - Karen Chau
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
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30
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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2022; 19:684-703. [PMID: 35449407 PMCID: PMC9982688 DOI: 10.1038/s41569-022-00687-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.
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Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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31
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Yamamoto MH, Kondo S, Mizukami T, Yasuhara S, Wakabayashi K, Kobayashi N, Sambe T, Hibi K, Nanasato M, Sugiyama T, Kakuta T, Kondo T, Mitomo S, Nakamura S, Takano M, Yonetsu T, Ashikaga T, Dohi T, Yamamoto H, Kozuma K, Yamashita J, Yamaguchi J, Ohira H, Mitsumata K, Namiki A, Kimura S, Honye J, Kotoku N, Higuma T, Natsumeda M, Ikari Y, Sekimoto T, Mori H, Suzuki H, Otake H, Isomura N, Ochiai M, Suwa S, Shinke T. Rationale and design of the TACTICS registry: Optical coherence tomography guided primary percutaneous coronary intervention for patients with acute coronary syndrome. J Cardiol 2022; 80:505-510. [PMID: 35907707 DOI: 10.1016/j.jjcc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Recent retrospective investigations have suggested that optical coherence tomography (OCT) enables the diagnosis of underlying acute coronary syndrome (ACS) causes such as plaque rupture, plaque erosion, and calcified nodule. The relationships of these etiologies with clinical outcomes, and the clinical utility of OCT-guided primary percutaneous coronary intervention (PCI) are not systematically studied in real-world ACS treatment settings. METHODS The TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 21 hospitals in Japan. A total of 700 patients with ACS (symptom onset within 24 h) undergoing OCT-guided primary PCI will be enrolled. The primary endpoint of the study is to identify the underlying causes of ACS using OCT-defined morphological assessment of the culprit lesion. The key secondary clinical endpoints are hazard ratios of the composite of cardiovascular death, non-fatal myocardial infarction, heart failure, or ischemia-driven revascularization in patients with underlying etiologies at the 12- and 24-month follow-ups. The feasibility of OCT-guided primary PCI for ACS will be assessed by the achievement rates of optimal post-procedural results and safety endpoints. CONCLUSION The TACTICS registry will provide an overview of the underlying causes of ACS using OCT, and will reveal any difference in clinical outcomes depending on the underlying causes. The registry will also inform on the feasibility of OCT-guided primary PCI for patients with ACS.
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Affiliation(s)
- Myong Hwa Yamamoto
- Division of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Seita Kondo
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takuya Mizukami
- Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University, Tokyo, Japan; Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Sakiko Yasuhara
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Kohei Wakabayashi
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital Tokyo, Japan
| | - Nobuaki Kobayashi
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Takehiko Sambe
- Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University, Tokyo, Japan; Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takeshi Kondo
- Department of Medicine, Hitachi Medical Center Hospital, Ibaraki, Japan
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Masamichi Takano
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Kanagawa, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Junko Honye
- Division of Cardiology, Kikuna Memorial Hospital, Kanagawa, Japan
| | - Nozomi Kotoku
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Makoto Natsumeda
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoei Isomura
- Division of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masahiko Ochiai
- Division of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
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Alasnag M, Ahmed W, Al-Bawardy R, Shammeri OA, Biswas S, Johnson TW. Optimising PCI by Intracoronary Image-guidance. Front Cardiovasc Med 2022; 9:878801. [PMID: 35647055 PMCID: PMC9136172 DOI: 10.3389/fcvm.2022.878801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled trials demonstrating a benefit in acute procedural and clinical outcomes. ICI provides an opportunity to guide PCI, detailing the nature of the coronary disease, potentially influencing lesion preparation and stent selection. Following stent deployment, ICI offers a detailed assessment of lesion coverage, associated vessel trauma and stent expansion. Consensus statements have emphasized the role of ICI and detailed the parameters of stent optimization. However, intracoronary imaging is not adopted widely yet. Significant global differences in the uptake of ICI have been reported, with the vast majority of PCI being angiographically-guided. The three major barriers to the implementation of ICI include, in order of impact, prohibitive cost, prolongation of procedure time and local regulatory issues for use. However, it is our belief that a lack of education and the associated challenges of ICI interpretation provide the greatest barrier to adoption. We hope that this review of the role of ICI in PCI optimization will provide a platform for PCI operators to gain confidence in the utilization of ICI to enhance outcomes for their patients.
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Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- *Correspondence: Mirvat Alasnag
| | - Waqar Ahmed
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Rasha Al-Bawardy
- King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | | | - Sinjini Biswas
- Bristol Heart Institute, Translational Health Science, University of Bristol, Bristol, United Kingdom
| | - Thomas W. Johnson
- Bristol Heart Institute, Translational Health Science, University of Bristol, Bristol, United Kingdom
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Gupta A, Shrivastava A, Vijayvergiya R, Chhikara S, Datta R, Aziz A, Singh Meena D, Nath RK, Kumar JR. Optical Coherence Tomography: An Eye Into the Coronary Artery. Front Cardiovasc Med 2022; 9:854554. [PMID: 35647059 PMCID: PMC9130606 DOI: 10.3389/fcvm.2022.854554] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/24/2022] [Indexed: 01/20/2023] Open
Abstract
Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains subdued. However, upcoming newer trials and data have been encouraging for expanding the use of OCT to wider indications in clinical utility. During percutaneous coronary intervention (PCI), OCT provides the detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition) required for optimal stent deployment, which is the key to successfully reducing the major adverse cardiovascular event (MACE) and stent-related morbidities. The increasing use of OCT in complex bifurcation stenting involving the left main (LM) is being studied. Also, the traditional pitfalls of OCT, such as additional contrast load for image acquisition and stenting involving the ostial and proximal LM, have also been overcome recently. In this review, we discuss the interpretation of OCT images and its clinical impact on the outcome of procedures along with current barriers to its use and newer paradigms in which OCT is starting to become a promising tool for the interventionalist and what can be expected for the immediate future in the imaging world.
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Early vascular healing after implantation of the polymer-free biolimus-eluting stent or the ultrathin strut biodegradable polymer sirolimus-eluting stent in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2022; 33:196-205. [PMID: 34985003 DOI: 10.1097/mca.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the difference in early vascular healing between the ultrathin-strut biodegradable-polymer sirolimus-eluting Orsiro stent (O-SES) and the polymer-free biolimus-A9-eluting BioFreedom stent (BF-BES), assessed with optical coherence tomography (OCT) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarctions (STEMIs). METHODS Eighty patients with STEMI who underwent primary PCI were randomly allocated 1:1 to treatment with BF-BES or O-SES. OCT was acquired after PCI and at 1-month follow-up. The primary endpoint was 1-month OCT-assessed vascular healing index based on the presence of uncovered and malapposed stent struts and intraluminal filling defects where low vascular healing index indicated favorable vascular healing. RESULTS At 1-month, the vascular healing index was similar in O-SES 11.5 [interquartile range (IQR) 9.5-17.5], compared to BF-BES 11.5 (IQR 7.1-12.5; P = 0.14). Percentage of uncovered struts [O-SES 31.5% (IQR 20.7-41.9), P = 0.43] vs. BF-BES 27.8% (IQR 19.4-41.9; P = 0.44), and median volume of neointimal hyperplasia [O-SES 4.9 mm3 (IQR 1.4-13.1) vs. BF-BES 7.1 mm3 (IQR 2.8-17.0), P = 0.18] did not differ significantly between the two stent groups. Complete coverage was not observed in any of the stents. The percentages of stents with malapposition did not differ significantly (O-SES 87.1% vs. BF-BES 71.4%, P = 0.14) whereas percentage of malapposed struts [O-SES 3.5% (IQR 0.8-5.5) vs. BF-BES 0.8% (IQR 0.0-1.8), P = 0.003] was lower in the BF-BES group. CONCLUSION In patients with STEMI, the drug-coated BF-BES and the thin strut O-SES had similar vascular healing index at 1-month. However, the thin O-SES struts were more often malapposed.
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Fallesen CO, Antonsen L, Maehara A, Noori M, Hougaard M, Hansen KN, Ellert J, Ahlehoff O, Veien KT, Lassen JF, Junker AB, Hansen HS, Jensen LO. Optical coherence tomography versus angiography guided magnesium bioresorbable scaffold implantation in NSTEMI patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:101-110. [PMID: 34949544 DOI: 10.1016/j.carrev.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of a bioresorbable scaffold (BRS) is to provide radial support during coronary healing. In this study, coronary artery healing after optical coherence tomography (OCT)- versus angiography-guided magnesium BRS (MBRS) implantation in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) is compared. METHODS 75 patients were randomized 1:1 to OCT- or angiography-guided implantation of a MBRS with protocolled pre- and post-dilation. In the OCT-guided group, prespecified criteria indicating additional intervention were (1) scaffold under-expansion, (2) strut malapposition, (3) edge dissection, and (4) residual stenosis at distal or proximal reference segments. The primary endpoint was OCT-derived healing stage at 6 months. RESULTS At 6 months, there was no difference in average healing stage between OCT- and angiography-guided intervention (4.6 [interquartile range (IQR): 4.5-4.7] versus 4.5 [IQR: 4.3-4.7]; p = 0.54). The MBRSs were completely resolved in 77.0% [IQR: 68.5-85.5] versus 76.5% [IQR: 67.9-85.5]; (p = 0.97). Minimal lumen area (MLA) was reduced at 6 months in both the OCT- (32.3%; p < 0.01) and the angiography-guided group (21.3%; p < 0.01), however OCT-guided implantation was associated with a greater reduction of total lumen volume (-27.1 ± 32.5 mm3 versus -5.0 ± 32.9 mm3; p < 0.01) and MLA (-2.3 ± 1.6 mm2 vs. -1.4 ± 1.4 mm2; p = 0.02). CONCLUSIONS In NSTEMI patients, OCT-guidance with protocolled pre- and post-dilation of MBRS implantation showed similar healing pattern at 6 months compared to angiography-guidance alone. CLINICAL TRIAL REGISTRATION The Coronary Artery Healing Process after Optical Coherence Tomography Guided Percutaneous Coronary Intervention with Magmaris Bioresorbable Scaffold in Patients with Non-ST-Segment-Elevation Myocardial Infarction: (HONEST) trial is registered with ClinicalTrials.gov, NCT03016624.
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Affiliation(s)
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Akiko Maehara
- Cardiovascular Research Foundation, NY Presbyterian Hospital, New York, USA
| | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Julia Ellert
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Bo Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 486] [Impact Index Per Article: 162.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Ghafari C, Carlier S. Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency. World J Cardiol 2021; 13:416-437. [PMID: 34621487 PMCID: PMC8462039 DOI: 10.4330/wjc.v13.i9.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Evaluation of acute percutaneous coronary intervention (PCI) results and long-term follow-up remains challenging with ongoing stent designs. Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion, improving overall PCI results and reducing adverse cardiac events. Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results. Digital stent enhancement methods have been well validated and improved stent strut visualization. Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure. With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results. We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
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Affiliation(s)
| | - Stéphane Carlier
- Department of Cardiology, UMONS, Mons 7000, Belgium
- Department of Cardiology, CHU Ambroise Paré, Mons 7000, Belgium
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Demola P, Mattesini A. Optical coherence tomography guidance: when one size does not fit all. Eur Heart J Cardiovasc Imaging 2021; 22:760-764. [PMID: 33409532 DOI: 10.1093/ehjci/jeaa319] [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: 11/13/2022] Open
Affiliation(s)
- Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
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Häner JD, Duband B, Ueki Y, Otsuka T, Combaret N, Siontis GCM, Bär S, Stortecky S, Motreff P, Losdat S, Windecker S, Souteyrand G, Räber L. Impact of intracoronary optical coherence tomography in routine clinical practice: A contemporary cohort study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:96-103. [PMID: 34340915 DOI: 10.1016/j.carrev.2021.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/PURPOSE Guidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice. METHODS/MATERIALS We conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed. RESULTS OCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% (N = 542) and OCT-guided percutaneous coronary intervention in 50% (N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss). CONCLUSIONS OCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients.
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Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Duband
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Sylvain Losdat
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Stevenson A, Kirresh A, Ahmad M, Candilio L. Robotic-assisted PCI: The future of coronary intervention? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:161-168. [PMID: 33867293 DOI: 10.1016/j.carrev.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Abstract
Robotic percutaneous coronary intervention (R-PCI) is a novel approach to performing percutaneous coronary intervention (PCI) whereby the operator can utilise remotely controlled technology to manipulate guidewires and catheter devices. This enables the procedure to be undertaken from within a radiation-shielded cockpit. Success in early trials has led to the release of commercially available robotic platforms which have now received regulatory approval and are available for use in clinical practice. Recent trials evaluating R-PCI have demonstrated high technical success rates with low complication rates. Despite this, a significant number of cases, particularly those with complex anatomy, still require at least partial conversion to a manual procedure. Advantages of R-PCI include accurate stent placement, reduced operator radiation exposure and a presumed reduction in orthopedic injuries. Limitations include current incompatibility with certain intravascular imaging catheters and the inability to manipulate multiple guidewires and stents simultaneously. Patients presenting with ST-elevation myocardial infarction requiring primary-PCI have also largely been excluded from existing R-PCI studies. Given these caveats, R-PCI remains a novel technology and has yet to become commonplace in cardiac catheterisation laboratories, however with increasing safety and feasibility data emerging, it is possible that R-PCI may form part of standard practice in the future.
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Affiliation(s)
- Alexander Stevenson
- Department of Intensive Care, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland.
| | - Ali Kirresh
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Luciano Candilio
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
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Roland R, Veselka J. Optical Coherence Tomography of the Coronary Arteries. Int J Angiol 2021; 30:29-39. [PMID: 34045841 DOI: 10.1055/s-0041-1724019] [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: 10/22/2022] Open
Abstract
Intravascular imaging, particularly optical coherence tomography, has brought significant improvement in diagnostic and therapeutical approaches to coronary artery disease and has offered superior high-resolution visualization of coronary arteries. The ability to obtain images of intramural and transmural coronary structures allows the study of the process of atherosclerosis, effect of therapies, mechanism of acute coronary syndrome and stent failure, and performance of new devices and enables the interventional cardiologist to optimize the effect of percutaneous coronary intervention. In this review, we provide the summary of the latest published data on clinical use of optical coherence tomography as well as practical algorithm for optical coherence tomography-guided percutaneous coronary intervention for daily interventional practice.
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Affiliation(s)
- Robert Roland
- Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
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Fallesen CO, Maehara A, Antonsen L, Nørregaard Hansen K, Noori M, Flensted Lassen J, Junker A, Hansen HS, Okkels Jensen L. Coronary Artery Healing Process after Bioresorbable Scaffold in Patients with Non-ST-Segment Elevation Myocardial Infarction: Rationale, Design, and Methodology of the HONEST Study. Cardiology 2021; 146:161-171. [PMID: 33524985 DOI: 10.1159/000512417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bioresorbable scaffolds (BRSs) is a relatively new approach in treating coronary artery stenosis. The initial results of the first commercially available scaffolds consisting of a backbone of poly-L-lactide raised safety concerns related to delayed resorption and healing. The magnesium alloy-based scaffold degrades via bio-corrosion within months, whereas it often takes several years for polymer scaffolds to degrade. The aim of the study was to assess the healing stage by optical coherence tomography (OCT) after 6 months in patients with non-ST-segment elevation myocardial infarct (NSTEMI) randomized to OCT or angiography-guided percutaneous coronary intervention with implantation of a magnesium sirolimus-eluting Magmaris scaffold (Magmaris; Biotronik, Bülach, Switzerland). METHODS We analyzed the healing process by comparing OCT at baseline and after 6 months. Five stages of healing were defined with stage 1 being the least healed and stage 5 demonstrating complete resorption and healing with no visible scaffold/remnant. The primary end point is a calculated healing score that is based on 5 subtypes of healing stage: (1) malapposed, (2) uncovered with no detection of smooth surface tissue on top of struts or remnants, (3) covered protruding, (4) covered embedded, and (5) complete healing with a smooth neointimal surface and no sign of struts or visible remnants assessed by OCT 6 months after the index procedure. RESULTS The impact of OCT-guided compared to angiography-guided scaffold implantation will be illuminated. CONCLUSION The present study will provide new information on midterm healing properties of the magnesium BRS in patients with NSTEMI.
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Affiliation(s)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York Presbyterian Hospital, New York, New York, USA
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Oosterveer TTM, van der Meer SM, Scherptong RWC, Jukema JW. Optical Coherence Tomography: Current Applications for the Assessment of Coronary Artery Disease and Guidance of Percutaneous Coronary Interventions. Cardiol Ther 2020; 9:307-321. [PMID: 32564339 PMCID: PMC7584694 DOI: 10.1007/s40119-020-00185-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Coronary angiography (CAG) is the standard modality for assessment of coronary stenoses and intraprocedural guidance of percutaneous coronary interventions (PCI). However, the limitations of CAG are well recognized. Intracoronary imaging (ICI) can potentially overcome these limitations. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the main ICI techniques utilized in clinical practice. AIM This narrative literature review addresses the current clinical applications of OCT in relation to IVUS and CAG in patients with coronary artery disease (CAD). Items reviewed are: technical implications of OCT and IVUS, lesion characterization and decision-making, stent optimization criteria, post-stenting results, safety in terms of procedural complications, clinical outcomes, and indications. MAIN FINDINGS OCT is able to reveal more detail than IVUS due to its higher resolution. However, this higher resolution comes at the cost of a lower penetration depth. Pre-stenting OCT results in procedural change in more than 50% of the cases in terms of stent length and diameter. Post-stenting OCT resulting in stent optimization is reported in at least 27% of the cases. Malapposition and under-expansion are treated with post-dilatations, while edge dissections are treated with additional stent placement. Stent expansion, stent apposition, distal stent edge dissections, and reference lumen areas seem to be the most important stent optimization criteria for both decision-making and for reducing the risk of adverse events during follow-up. Both OCT and IVUS are superior in terms of post-stenting results compared with CAG alone. However, there is no consensus about whether OCT guidance results in better stent expansion than IVUS guidance. OCT, IVUS, and CAG are safe procedures with few reported procedural complications. In general, OCT guidance seems to contribute to favorable clinical outcomes compared with CAG guidance only. However, OCT guidance results in similar clinical outcomes as with IVUS guidance. OCT could be considered for lumen assessment and stent-related morphology in more complex cases in which CAG interpretation remains uncertain. Since OCT and IVUS have distinct characteristics, these techniques are complementary and should be considered carefully for each patient case based on the benefits and limitations of both techniques.
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Affiliation(s)
- Timo T M Oosterveer
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Yacob O, Garcia-Garcia HM, Dan K, Soud M, Adamo M, Picchi A, Sardella G, Frigoli E, Limbruno U, Rigattieri S, Diletti R, Boccuzzi G, Zimarino M, Contarini M, Russo F, Calabro P, Ando G, Varbella F, Garducci S, Palmieri C, Briguori C, Kuku KO, Karagiannis A, Valgimigli M. Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study. Int J Cardiovasc Imaging 2020; 37:1143-1150. [PMID: 33225426 DOI: 10.1007/s10554-020-02098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association of the degree of stent expansion, as assessed by optical coherence tomography (OCT), following stent implantation, and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients. METHODS STEMI patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) OCT study were selected; Clinical outcomes were collected through 1 year. Stent expansion index is a minimum stent area (MSA) divided by average lumen area (average of proximal and distal reference lumen area). The following variables were measured: MSA (< 4.5mm2), dissection (> 200 µm in width and < 5 mm from stent segment), malapposition (> 200 µm distance of stent from vessel wall), a thrombus (area > 5% of lumen area) were compared. RESULTS A total of 151 patients were included; after excluding patients with suboptimal OCT quality, the population with available OCT was classified into 2 groups: under-expanded < 90% (N = 72, 51%) and well-expanded ≥ 90% (N = 67, 49%). In the well-expanded group, a significant number of the proximal vessels had a lumen area < 4.5mm2 (16.1%, p < 0.001) and a greater thrombus burden within stent (56.7%, p = 0.042). The overall 30 day and 1 year major adverse cardiovascular event (MACE) rates were 5% and 6.1%, respectively. CONCLUSION Irrespective of the degree of stent expansion, the OCT findings, in STEMI patients, and the MACE at 30 days and one year follow up was low; further, well-expanded stents led to a more significant residual thrombotic burden within the stent but seemed to have insignificant clinical impact. Acknowledged stent optimization criteria, traditionally related to worse outcomes in stable patients, do not seem to be associated with worse outcomes in this STEMI population.
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Affiliation(s)
- Omar Yacob
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Kazuhiro Dan
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Mohamad Soud
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardio-Thoracic Department, University of Brescia, Brescia, Italy
| | - Andrea Picchi
- Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Ugo Limbruno
- Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy
| | | | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Marco Zimarino
- Institute of Cardiology "G. D'Annunzio" University, Chieti, Italy
| | - Marco Contarini
- Interventional Cardiology Unit Umberto I Hospital, Syracuse, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, Cardio-thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Calabro
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Ando
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Stefano Garducci
- Unita' Operativa Complessa Di Cardiologia ASST Di Vimercate (MB), Vimercate, Italy
| | - Cataldo Palmieri
- Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Pisa/Massa, Italy
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Napoli, Italy
| | - Kayode O Kuku
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Marco Valgimigli
- Swiss Cardiovascular Center, University of Bern, Bern, Switzerland.
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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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Hansen KN, Antonsen L, Maehara A, Mæng M, Ellert J, Ahlehoff O, Veien KT, Hansen KN, Noori M, Fallesen CO, Thim T, Christiansen EH, Jensen LO. Influence of Plaque Characteristics on Early Vascular Healing in Patients With ST-Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 30:50-58. [PMID: 33012685 DOI: 10.1016/j.carrev.2020.09.033] [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: 04/13/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the early vascular healing of ruptured plaques (RP) and non-ruptured plaques (NRP) one month after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), using optical coherence tomography (OCT). BACKGROUND Vascular healing and strut coverage are important factors in reducing the risk of stent thrombosis after PCI. Influence of underlying lesion characteristics and differences in healing response between RP and NRP are unknown. METHODS Twenty-six STEMI-patients underwent PCI and implantation of a polymer-free drug-coated Biofreedom stent (BF-BES). OCT was performed pre-PCI, post-PCI and at 1-month follow-up. The patients were divided into two groups: RP = 15 and NRP = 11. OCT analyses of culprit lesion, post stent implantation at baseline and follow-up were performed to determine the difference in vascular healing based on presence of uncovered and/or malapposed stent struts and intraluminal filling defects. RESULTS The stent coverage did not differ significantly between the two groups at 1-month follow-up with percentage of uncovered struts: RP 26.5% [IQR 15.0-49.0] and NRP 28.1% [IQR 15.5-38.8] for NRP (p = 0.78). At 1-month, RP showed an increased percentage of late acquired malapposed struts (1.4% [IQR 0.8-2.4] vs. 0.0% [IQR 0.0-1.4], p = 0.03) and a larger total malapposition area (1.3 mm2 [IQR 0.4-2.5] vs. 0.0 mm2 [IQR 0.0-0.9], p = 0.01), compared to NRP. CONCLUSION Three out of four struts were covered within one month after stenting. The vascular healing was comparable in RP and NRP on stent coverage. However, RP had more and larger late acquired malapposition areas.
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Affiliation(s)
- Kirstine N Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Michael Mæng
- Department of Cardiology, Aarhus University Hospital, Arhus, Denmark
| | - Julia Ellert
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Arhus, Denmark
| | | | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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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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Ueki Y, Yamaji K, Barbato E, Nef H, Brugaletta S, Alfonso F, Hill J, Cook S, Burzotta F, Karagiannis A, Windecker S, Räber L. Randomized Comparison of Optical Coherence Tomography Versus Angiography to Guide Bioresorbable Vascular Scaffold Implantation: The OPTICO BVS Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1244-1250. [PMID: 32205067 DOI: 10.1016/j.carrev.2020.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/24/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We investigated whether optical coherence tomography (OCT)-guided bioresorbable vascular scaffolds (BVS) implantation can improve in-scaffold minimal lumen area (MLA) at 6-month compared with angiography guidance. METHODS The OPTICO BVS was a randomized, international multicenter, assessor blind, superiority trial comparing OCT- versus angiography-guided percutaneous coronary intervention (PCI) (1:1 allocation) in patients with coronary artery disease undergoing Absorb BVS 1.1 implantation. The primary endpoint was in-scaffold MLA at 6-month. RESULTS The trial was prematurely stopped on May 31, 2017 after enrollment of 38 of 270 planned patients (14%) following the retraction of the device in Europe. Patients were randomly assigned to OCT- (n = 19) or angiography-guided PCI (n = 19). Scaffold diameter (OCT 3.0 ± 0.3 mm vs. angiography 3.1 ± 0.3 mm, P = .333) and length (28.8 ± 13.6 mm vs. 23.8 ± 12.3 mm, P = .223) were comparable. There was no significant difference in in-scaffold MLA at 6 months (4.47mm2 vs. 5.08mm2, P = .692). Scaffold expansion at 6-month was significantly higher in the OCT-guided PCI as compared with angiography-guided PCI (84.5% vs. 76.5%, P = .010). There was no significant difference in clinical outcomes. CONCLUSIONS Although in-scaffold MLA at 6-month did not differ between groups, scaffold expansion was improved following OCT- as compared with angiography-guided PCI. The findings of this study must be interpreted in view of the premature termination with inclusion of 14% of the initially planned study sample.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Emanuele Barbato
- Cardiovascular center Aalst, OLV clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Salvatore Brugaletta
- Clinic Cardiovascular institute, University Hospital Clinic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Jonathan Hill
- Cardiac department, King's College Hospital, London, United Kingdom
| | - Stéphane Cook
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alexios Karagiannis
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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