Background
To estimate the impact of intravascular ultrasound (IVUS) in patients with chronic limb‐threatening ischemia (CLTI) who underwent balloon angioplasty for isolated infrapopliteal lesion.
Methods
The study was performed as a single‐center, prospective maintained database, retrospective analysis. Between January 2013 and December 2018, consecutive 155 CLTI patients (155 limbs) who primarily underwent balloon angioplasty for de novo isolated infrapopliteal atherosclerotic lesions with Rutherford category class 4 or 5 were identified (IVUS‐guided: 92 patients, angio‐guided: 63 patients) and included in the analysis. We compared clinical outcomes in IVUS‐guided group with that in angio‐guided group. The primary endpoint was limb salvage without any reintervention. The main secondary endpoints were wound healing rate and time to wound healing in the tissue loss group.
Result
Patient and limb characteristics were similar between the two groups. The IVUS‐guided group was treated with a larger balloon size for all types of below‐the‐knee vessel (p < .001), although lesion characteristics, including the QVA‐measured vessel diameter, were similar between the two groups. The IVUS‐guided group had a higher rate of limb salvage without any reintervention than the angio‐guided group (p = 0028). Whereas limb salvage and overall survival was not significantly different. Wound healing was significantly earlier and the time to wound healing was significantly shorter (84 ± 55 days vs. 135 ± 118 days, p = .007) in the IVUS‐guided group.
Conclusion
Limb salvage rate without any reintervention in IIVUS‐guided balloon angioplasty group was significantly higher than that in angio‐guided balloon angioplasty group in patients with CLTI due to isolated infrapopliteal disease.
Background
Heart failure might be an important determinant in choosing coronary revascularization modalities. There was no previous study evaluating the effect of heart failure on long‐term clinical outcomes after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG).
Methods and Results
Among 14 867 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013 in the CREDO‐Kyoto PCI/CABG registry Cohort‐3, we identified the current study population of 3380 patients with three‐vessel or left main coronary artery disease, and compared clinical outcomes between PCI and CABG stratified by the subgroup based on the status of heart failure. There were 827 patients with heart failure (PCI: N=511, and CABG: N=316), and 2553 patients without heart failure (PCI: N=1619, and CABG: N=934). In patients with heart failure, the PCI group compared with the CABG group more often had advanced age, severe frailty, acute and severe heart failure, and elevated inflammatory markers. During a median 5.9 years of follow‐up, there was a significant interaction between heart failure and the mortality risk of PCI relative to CABG (interaction
P
=0.009), with excess mortality risk of PCI relative to CABG in patients with heart failure (HR, 1.75; 95% CI, 1.28–2.42;
P
<0.001) and no excess mortality risk in patients without heart failure (HR, 1.04; 95% CI, 0.80–1.34;
P
=0.77).
Conclusions
There was a significant interaction between heart failure and the mortality risk of PCI relative to CABG with excess risk in patients with heart failure and neutral risk in patients without heart failure.
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