Impact of intravascular ultrasound‐guided drug‐eluting stent implantation on patients with chronic kidney disease: Results from ULTIMATE trial

Abstract

Objectives This study aimed to investigate the impacts of intravascular ultrasound (IVUS)‐guided drug‐eluting stent (DES) implantation on patients with chronic kidney disease (CKD) based on the ULTIMATE trial. Background IVUS‐guided DES implantation improves clinical outcomes in complex lesions. However, routine IVUS guidance in patients with CKD remains controversial. Methods CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL min−1 1.73 m−2. The primary end point was target vessel failure (TVF) at 12 months, including cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. Results eGFR was available in 1,443 patients, of whom 723 were in the IVUS guidance group, and 720 were in the angiography guidance group. Finally, CKD was present in 349 (24.2%) patients. At 12 months, TVF in the CKD group was 7.2%, which was significantly higher than 3.2% in the non‐CKD group (p = .001). Moreover, there were 25 TVFs in the CKD patients, with 7 (3.9%) TVFs in the IVUS group and 18 (10.7%) TVFs in the angiography group (hazard ratio [HR]: 0.35; 95% confidence interval [CI]: 0.15–0.84; p = .01), whereas 35 TVFs occurred in patients without CKD, with 14 (2.6%) TVFs in the IVUS group and 21 (3.8%) TVFs in the angiography group (HR: 0.67; 95% CI: 0.34–1.32; p = .25; p for interaction = .24). Conclusions This study demonstrated that CKD patients undergoing DES implantations were associated with a higher risk of TVF at 12 months. More importantly, the risk of TVF in the CKD patients could be significantly decreased through IVUS guidance. Clinical Trial NCT02215915.

Impact of Intracoronary Imaging‐Guided Percutaneous Coronary Intervention on Procedural Outcomes Among Complex Patient Groups

“… 9 A substudy from the ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All‐Comers” Coronary Lesions) randomized trial demonstrated lower target vessel failure (TVF) (hazard ratio [HR], 0.12 [95% CI, 0.02–0.93]) and target vessel MI (HR, 0.12 [95% CI, 0.02–0.93]) with IVUS use compared with angiography guided PCI among 349 patients with chronic kidney disease. 18 However, the hazards for other outcomes, including mortality, were either insignificant or incalculable because of their small sample size. While our findings suggest that ICI was associated with lower in‐hospital mortality in cases with an EAPCI imaging‐recommended indication, this was only the case with certain indications including renal failure, stent thrombosis, LMS PCI, ACS indication, and stent length >60 mm.…”

“… 2 , 20 , 21 , 22 Similarly, the use of ICI in patients with renal failure minimizes their exposure to higher volumes of contrast and subsequent risk of contrast‐induced nephropathy, which is independently associated with higher mortality and MACE, as well as minimizes their risk of future stent failure. 18 , 23 …”

Safety and Efficacy of Minimum- or Zero-Contrast IVUS–Guided Percutaneous Coronary Interventions in Chronic Kidney Disease Patients: A Systematic Review

“…The next step forward appeared to be Zhang’s trial [ 24 ], in which study populations consisted only of CKD patients (in fact, it was a post-hoc analysis from the ULTIMATE trial) [ 25 ], and the comparison was between standard and IVUS-guided procedures. Likewise, the idea of low-contrast procedures in CKD was not taken into account.…”

Plasma Small Extracellular Vesicle‐Carried miRNA‐501‐5p Promotes Vascular Smooth Muscle Cell Phenotypic Modulation‐Mediated In‐Stent Restenosis

“…The method and results of ULTIMATE trial have been reported previously [14,15]. This trial was performed in accordance with Declaration of Helsinki and International conference, and the protocol was approved by the ethics committee of each participating center.…”