Impact of intravascular ultrasound-guided minimum-contrast coronary intervention on 1-year clinical outcomes in patients with stage 4 or 5 advanced chronic kidney disease

Sakai, Katsuaki; Ikari, Yuji; Nanasato, Mamoru; Umetsu, Hiroshi; Okutsu, Masaaki; Takikawa, Tomonobu; Sumitsuji, Satoru; Sadamatsu, Kenji; Takada, Masanori; Kato, Yasuko; Ogasawara, Nobuyuki; Otowa, Kanichi

doi:10.1007/s12928-018-0552-7

Cited by 35 publications

(35 citation statements)

References 16 publications

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“…The benefit of IVUS‐guided DES implantation may be attributed to the larger stent/balloon sizes and a more frequent post‐dilation from IVUS guidance, which could then result in a larger, postprocedural, minimal lumen diameter, which could subsequently reduce adverse events. Currently, several small‐sized studies have focused on the feasibility and safety of IVUS‐guided zero or minimal contrast coronary intervention in reducing CIN risks in CKD patients, which are inconsistent with our data. In our study protocol, in order to achieve optimal IVUS guidance criteria, multiple IVUS check and additional post‐dilation or stent were performed accordingly, which leaded to a higher contrast volume in the IVUS guidance group, but the risk of CIN was not increased.…”

Section: Discussioncontrasting

confidence: 92%

“…Currently, several small-sized studies [21][22][23] have focused on the feasibility and safety of IVUS-guided zero or minimal contrast coronary intervention in reducing CIN risks in CKD patients, which are inconsistent with our data. In our study protocol, in order to achieve optimal IVUS guidance criteria, multiple IVUS check and additional post-dilation or stent were performed accordingly, which leaded to a higher contrast volume in the IVUS guidance group, but the risk of CIN was not increased.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Gao

et al. 2019

Cathet Cardio Intervent

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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.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Zhang

Gao

et al. 2019

Cathet Cardio Intervent

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“…30 A study involving the PCI subgroup of minimum-contrast studies demonstrated that IVUS-guided PCI procedure facilitates minimal contrast use and subsequently reduce the incidence of contrast-induced acute kidney injury (AKI) and renal replacement therapy. 31 Dextran may also be used in OCT-guided PCI which seemed to be non-nephrotoxic if administered <100 ml. 30 The efficient and judicious use of CM through "ultra-low contrast technique" has been described to be feasible, effective, and safe; this technique involved use of small catheters without side-holes and approach to minimize CM injection.…”

Section: Discussionmentioning

confidence: 99%

“…One of them is the use of zero‐/ultra‐low‐contrast‐volume PCI protocol which can be achieved by using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) as guidance for PCI 30 . A study involving the PCI subgroup of minimum‐contrast studies demonstrated that IVUS‐guided PCI procedure facilitates minimal contrast use and subsequently reduce the incidence of contrast‐induced acute kidney injury (AKI) and renal replacement therapy 31 . Dextran may also be used in OCT‐guided PCI which seemed to be non‐nephrotoxic if administered <100 ml 30 .…”

Section: Discussionmentioning

confidence: 99%

Remote ischemic preconditioning reduces the incidence of contrast‐induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta‐analysis of randomized controlled trials

Pranata

Tondas

Vania

et al. 2020

Cathet Cardio Intervent

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Background: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. Methods: We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. Results: There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p < .001; I 2 : 22%). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p < .001; I 2 : 26%) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p < .001; I 2 : 0%). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p = .001; I 2 : 0%). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate-high risk subgroup, and PCI-only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small-study effects (p = .157). Conclusions: Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate-high risk at developing CIN.

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“…Despite these positive results, IVUS-guided PCI did not reduce 1-year mortality in this population. 77,78 Recently, the concept of low contrast volume PCI in ESRD was presented by the pilot study conducted by Ali ZA et al 79 The group performed zero contrast PCI 1 week after performing IVUS, with pre-and post-measurements of fractional and coronary flow reserve, confirming good results without serious complications.…”

Section: Intra-vascular Ultrasonography (Ivus)mentioning

confidence: 95%

Multi‐modality cardiac imaging in advanced chronic kidney disease

Ureche

Sascău

Țăpoi³

et al. 2019

Echocardiography

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Cardiovascular disease (CVD) is the leading cause of death worldwide and is particularly frequent among those with severe renal impairment. Early diagnosis and therapeutic intervention may help alleviate the burden of cardiovascular complication within this population. In the last years, advances have been made toward developing noninvasive imaging techniques that could offer better insight into the cardiac involvement in end‐stage renal disease (ESRD). Conventional transthoracic echocardiography remains the first‐line investigation used to assess cardiac function, but encompassing in our daily practice, the newer approaches such as speckle‐tracking imaging, cardiac computed tomography, or cardiac magnetic resonance can guide us to a more comprehensive understanding of CVD in ESRD. Given that patients with chronic kidney disease may not present with typical CVD symptoms, the amount of information brought by newer imaging techniques is crucial for an accurate diagnosis, risk stratification, and further management. The purpose of this review is to briefly summarize the specific applications of standard cardiac imaging techniques in patients with ESRD and to offer insight into the novel imaging modalities, highlighting the newest research in this field. By doing so, we aim to identify the most important imaging predictors of clinical outcomes in this population.

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Impact of intravascular ultrasound-guided minimum-contrast coronary intervention on 1-year clinical outcomes in patients with stage 4 or 5 advanced chronic kidney disease

Cited by 35 publications

References 16 publications

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

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

Remote ischemic preconditioning reduces the incidence of contrast‐induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta‐analysis of randomized controlled trials

Multi‐modality cardiac imaging in advanced chronic kidney disease

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