P ercutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still challenging, and there are unmet needs even with the availability of drug-eluting stents (DESs). [1][2][3][4] Despite the development of novel techniques and technologies for CTO intervention, the increased clinical and angiographic risk factors accompanying more complex procedures have been associated with worse clinical outcomes. [3][4][5][6] The use of intravascular ultrasound (IVUS) has been recommended as 1 way to improve overall PCI clinical outcomes; however, few studies have evaluated its use during CTO intervention, and no randomized study has compared IVUS-guided CTO intervention with conventional angiography-guided intervention. 7-9Background-There have been no randomized studies comparing intravascular ultrasound (IVUS)-guided versus conventional angiography-guided chronic total occlusion (CTO) intervention using new-generation drug-eluting stent Therefore, we conducted a prospective, randomized, multicenter trial designed to test the hypothesis that IVUS-guided CTO intervention is superior to angiography-guided intervention. Methods and Results-After successful guidewire crossing, 402 patients with CTOs were randomized to the IVUS-guided group (n=201) or the angiography-guided group (n=201) and secondarily randomized to Resolute zotarolimus-eluting stents or Nobori biolimus-eluting stents. The primary and secondary end points were cardiac death and a major adverse cardiac event defined as the composite of cardiac death, myocardial infarction, or target-vessel revascularization, respectively. After 12-month follow-up, the rate of cardiac death was not significantly different between the IVUSguided group (0%) and the angiography-guided group (1.0%; P by log-rank test=0.16). However, major adverse cardiac event rates were significantly lower in the IVUS-guided group than that in the angiography-guided group (2.6% versus 7.1%; P=0.035; hazard ratio, 0.35; 95% confidence interval, 0.13-0.97). Occurrence of the composite of cardiac death or myocardial infarction was significantly lower in the IVUS-guided group (0%) than in the angiography-guided group (2.0%; P=0.045). The rates of target-vessel revascularization were not significantly different between the 2 groups. In the comparison between Resolute zotarolimus-eluting stent and Nobori biolimus-eluting stent, major adverse cardiac event rates were not significantly different (4.0% versus 5.7%; P=0.45). Conclusions-Although IVUS-guided CTO intervention did not significantly reduce cardiac mortality, this randomized study demonstrated that IVUS-guided CTO intervention might improve 12-month major adverse cardiac event rate after new-generation drug-eluting stent implantation when compared with conventional angiography-guided CTO intervention. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01563952. Kim et al Clinical Impact of IVUS-Guided CTO InterventionTherefore, we conducted a prospective, multicenter, randomized trial designed t...

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β-blocker treatment was associated with reduced long term mortality in patients with acute MI and preserved systolic function who received PCI.

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In patients with STEMI who had undergone primary PCI, the no-reflow phenomenon was an independent predictor of short-term but not long-term mortality.

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Receptor for advanced glycation end products (RAGE) and connective tissue growth factor (CTGF) play a key role in diabetic myocardial fibrosis, and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) activation has been reported to reduce RAGE and CTGF expression. This study investigated the effects of the PPAR-gamma agonist, rosiglitazone, on myocardial expression of RAGE and CTGF, extent of cardiac fibrosis, and left ventricular (LV) diastolic function in type 2 diabetic (T2D) rats. Twenty-week-old T2D rats were randomized to treatment with either 20 weeks of rosiglitazone (20 mg/kg) or saline (n = 10 in each group). Serial echocardiographic examinations were performed just before randomization (20 weeks) and at study completion (40 weeks). Fibrosis extent and RAGE and CTGF expression were assessed in previously imaged hearts by picrosirius red staining, and by real-time reverse transcriptase-coupled polymerase chain reaction (RT-PCR) and immunoblotting, respectively. Results of the latter assessments were further validated by immunohistochemical staining. Rosiglitazone treatment significantly improved E/A ratio in serial echocardiography assessment, and reduced LV collagen volume fraction as demonstrated by picrosirius red staining. Real-time RT-PCR and immunoblots of myocardial tissue from rosiglitazone-treated rats revealed reduced RAGE and CTGF mRNA and protein signals compared to those of saline-treated T2D rats, which were consistent with reduced proportions of myocardial RAGE and CTGF staining in the hearts of T2D rats. PPAR-gamma agonist therapy reduces cardiac fibrosis and improves LV diastolic dysfunction as assessed by serial echocardiographic imaging. Suppression of RAGE and CTGF expression in the diabetic myocardium appears to contribute to the antifibrotic effect of rosiglitazone. These results support the potential of PPAR-gamma agonists as antifibrotic agents in diabetic cardiomyopathy.

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