Comparison of Inhospital Mortality, Length of Hospitalization, Costs, and Vascular Complications of Percutaneous Coronary Interventions Guided by Ultrasound Versus Angiography

Singh, Vikas; Badheka, Apurva; Arora, Shilpkumar; Panaich, Sidakpal; Patel, Nileshkumar; Patel, Nilay; Pant, Sadip; Thakkar, Badal; Chothani, Ankit; Deshmukh, Abhishek; Manvar, Sohilkumar; Lahewala, Sopan; Patel, Jay; Patel, Samir; Jhamnani, Sunny; Bhinder, Jasjit; Patel, Parshva; Savani, Ghanshyambhai T.; Patel, Achint; Mohamad, Tamam; Gidwani, Umesh; Brown, Michael A.; Forrest, John K.; Cleman, Michael; Schreiber, Theodore; Grines, Cindy L.

doi:10.1016/j.amjcard.2015.02.037

Cited by 33 publications

(24 citation statements)

References 25 publications

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“…In contrast, another one large observational trial (9) indicated modest or no benefits of IVUS guidance in terms of the increased MACE risk (5.5% vs. 3.9%, p=0.148, for IVUS guidance vs. angiography guidance). In addition, Singh et al (10) cautiously pointed out that IVUS guidance was associated with lower in-hospital mortality risk at the cost of expensive care fee and increased incidence of vascular complications (10). Who could benefit mostly from IVUS guidance after costing a large number of treatment fee?…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, several large observational clinical trials (Obs) (4, 5) have indicated the benefits of IVUS guidance in terms of a lower rate of major adverse cardiac events (MACE) than angiography guidance, as well as these recent comprehensive meta-analyses (6–8). However, a study by Park et al (9) analyzing the data from the EXCELLENT trial (the Efficacy of Xience/Promus versus Cypher in rEducing Late Loss after stENTing) indicated no significant advantages of IVUS guidance, and another one recent observational trial (10) also showed doubt about the efficacy of IVUS guidance in DES implantation. In addition, the efficacy of IVUS guidance in patients with complex coronary lesions undergoing DES implantation still remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients

Fan

Gao²,

Li³

et al. 2017

Anatol J Cardiol

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Objective:The effects of intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation in patients with complex coronary artery lesions remains to be controversial. This study sought to evaluate the outcomes of IVUS guidance in these patients.Methods:The EMBASE, Medline, and other internet sources were searched for relevant articles. The primary endpoint was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularization (TVR). The incidence of definite/probable stent thrombosis (ST) was analyzed as the safety endpoint.Results:Fifteen clinical trials involving 8.084 patients were analyzed. MACE risk was significantly decreased following IVUS-guided DES implantation compared with coronary angiography (CAG) guidance (odds ratio [OR] 0.63, 95% confidence intervals [CI]: 0.53–0.73, p<0.001), which might mainly result from the lower all-cause mortality risk (OR 0.52, 95% CI: 0.40–0.67, p<0.001), MI (OR 0.70, 95% CI: 0.56–0.86, p=0.001), and TVR (OR 0.53, 95% CI: 0.40–0.70, p<0.001). The subgroup analyses indicated better outcomes of IVUS guidance in DES implantation for these patients with left main disease or bifurcation lesions.Conclusion:IVUS guidance in DES implantation is associated with a significant reduction in MACE risk in patients with complex lesions, particularly those with left main disease or bifurcation lesions. More large and powerful randomized trials are still warranted to guide stenting decision making. (Anatol J Cardiol 2017; 17: 258-68)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients

Fan

Gao²,

Li³

et al. 2017

Anatol J Cardiol

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show abstract

“…Data from the NIS have been used to identify, track and analyze national trends in healthcare usage, patterns of major procedures, access, disparity of care, trends in hospitalizations, charges, quality, and outcomes. [11][12][13] This was a cross sectional study using the NIS database between the years 2008-2012. Procedures were identified through appropriate clinical modification of International Classification of Diseases, ninth edition (ICD-9-CM) codes.…”

Section: Methodsmentioning

confidence: 99%

“…This methodology of identifying patients undergoing procedures, co-morbid conditions and associated complications has previously been utilized in several studies. 12,13,19 Statistical Analysis. Stata IC 11.0 (Stata-Corp, College Station, TX) and SAS 9.3 (SAS Institute Inc, Cary, NC).…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Coronary Interventions and Hemodynamic Support in the USA: A 5 Year Experience

Patel

Singh

Patel³

et al. 2015

J Interven Cardiology

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“…Also, more stents were implanted and stents were longer with IVUS-guided PCI to minimize geographic miss 6,10,149. However, IVUS penetration rate in the real world is still low.Except Japan which has unique separate reimbursement for IVUS, the United States shows the second highest penetration rate estimated at ~20% of patients undergoing PCI150,151 while Europe, the rest of Asia, and Latin and South America have much lower rates than the United States 152. Park SJ, Kang SJ, Ahn JM, et al Visual-functional mismatch between coronary angiography and fractional flow reserve.…”

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confidence: 99%

Value of intravascular ultrasound in guiding coronary interventions

Song¹,

Kang

Mintz

2018

Echocardiography

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

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Comparison of Inhospital Mortality, Length of Hospitalization, Costs, and Vascular Complications of Percutaneous Coronary Interventions Guided by Ultrasound Versus Angiography

Cited by 33 publications

References 25 publications

The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients

The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients

Percutaneous Coronary Interventions and Hemodynamic Support in the USA: A 5 Year Experience

Value of intravascular ultrasound in guiding coronary interventions

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