Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation

Zhang, Junjie; Gao, Xiaofei; Kan, Jing; Ge, Zhen; Han, Lei; Lu, Shey‐Shi; Tian, Nai‐Liang; Lin, Song; Lu, Qinghua; Wu, Xue-Ming; Li, Yongling; Liu, Zhizhong; Chen, Yan; Xu, Qian; Wang, Juan; Chai, Dayang; Chen, Chonghao; Li, Xiaolong; Gogas, Bill D.; Pan, Tao; Shan, Shou-Jie; Ye, Fei; Chen, Shao‐Liang

doi:10.1016/j.jacc.2018.09.013

Cited by 462 publications

(384 citation statements)

References 27 publications

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“…The use of IVUS with a high resolution could provide detailed anatomical information, could guide optimal stent selection and could optimize stent implantation. Our ULTIMATE trial 15 has established that IVUS-guided second-generation DES implantation (specifically, an IVUS-defined optimal procedure) significantly improves clinical outcomes in all-comer patients, compared with the outcomes of angiography guidance, rather than solely in those with complex lesions. 7-10 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.…”

Section: Discussioncontrasting

confidence: 93%

“…The methods and principal results of the ULTIMATE trial have been previously reported. 15 Briefly, the ULTIMATE trial was a prospective, multicenter, randomized study, in which 1,448 all-comer patients were randomized to undergo either IVUS-guided or angiographyguided second-generation DES implantations in eight Chinese centers from August 2014 to May 2017. The inclusion criteria were patients who had silent ischemia, stable or unstable angina, or myocardial infarctions (MIs, including both ST-elevation and non-ST-elevation MIs) >24 hr from the onset of chest pain to admission, as well as de novo coronary lesions that were eligible for DES implantation.…”

Section: Study Populationmentioning

confidence: 99%

“…The definitions of these end points have been previously described. 15 The present study was a prespecified subgroup analysis of the ULTIMATE trial for the evaluation of the impacts of IVUS-guided DES implantations on patients with CKD. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL min −1 1.73 m −2 for at least 3 months, according to the Cockcroft-Gault (CG) formula.…”

Section: Study End Points and Definitionsmentioning

confidence: 99%

“…Several randomized trials and observational studies have established the clinical benefits of IVUS-guided drugeluting stent (DES) implantation for patients with long lesions, 7,8 chronic total occlusions, 9,10 left main disease, 11,12 and complex bifurcation lesions. 13,14 Notably, the latest ULTIMATE trial 15 added new evidence of the benefits of IVUS guidance in all-comer coronary lesions.…”

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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: 93%

Section: Study Populationmentioning

confidence: 99%

Section: Study End Points and Definitionsmentioning

confidence: 99%

mentioning

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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“…3,4 Recent literatures have indicated potential advantage of intracoronary imaging in reducing the risk of major adverse cardiac events after stent implantation over conventional PCI under angiographic guidance. [5][6][7] Optical frequency domain imaging (OFDI) is an analogue of optical coherence tomography (OCT), which provides higher image resolution and higher-speed pullback than those of IVUS. 8,9 In recent trials, OCT/OFDI-guided PCI demonstrated comparable angiographic and clinical outcomes to those in IVUS-guided PCI.…”

mentioning

confidence: 99%

Associations of coronary plaque characteristics by integrated backscatter intravascular ultrasound with detectability of vessel external elastic lamina using optical frequency domain imaging in human coronary arteries: A sub‐analysis of the MISTIC‐1 trial

Ishikawa

Muramatsu

Nanasato

et al. 2019

Cathet Cardio Intervent

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Objectives We sought to examine associations between plaque characteristics by intravascular ultrasound (IVUS) and detectability of external elastic lamina (EEL) by optical frequency domain imaging (OFDI) in human coronary arteries. Background It is often challenging to detect EEL which represents vessel size by light‐based imaging modalities due to light intensity attenuation through atherosclerotic plaque. Methods IVUS and OFDI prior to stent implantation were sequentially investigated per protocol. We identified corresponding cross‐sections by minimum lumen area (MLA) or just distally to side branches as anatomical landmarks. Plaque characterization was determined by integrated backscatter IVUS analysis. We categorized detectable EEL arc by OFDI into four groups: 0≤ and <1 quadrant (group 1), 1≤ and <2 quadrants (group 2), 2≤ and <3 quadrants (group 3), or 3≤ and <4 quadrants (group 4). Results We prospectively studied 103 vessels in 93 patients with stable coronary artery disease. Corresponding 711 cross‐sections were analyzed. Cross‐sections with detectable EEL arc <2 quadrants (group 1 or 2) were observed in 86.1% of MLA sites but only in 29.3% of non‐MLA sites (p < .05). Percentage plaque area (%PA) appeared to be the strongest predictor to detect EEL arc <2 quadrants with the cut‐off of 60.3% (AUC 0.90; sensitivity 79.8%, specificity 85.5%). Lipid pool and calcification remained statistically significant in predicting detectable EEL arc <2 quadrants after adjustment with %PA. Conclusions Presence of large plaque burden, lipid pool, and calcification significantly predicts the detectability of EEL by OFDI assessment. Locations with detectable EEL arc <2 quadrants should thus be avoided for optimal stent landing zone.

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Quantitative Coronary Angiography vs Intravascular Ultrasonography to Guide Drug-Eluting Stent Implantation

Lee,

Hong,

Kim

et al. 2024

JAMA Cardiol

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ImportanceAlthough intravascular ultrasonography (IVUS) guidance promotes favorable outcomes after percutaneous coronary intervention (PCI), many catheterization laboratories worldwide lack access.ObjectiveTo investigate whether systematic implementation of quantitative coronary angiography (QCA) to assist angiography-guided PCI could be an alternative strategy to IVUS guidance during stent implantation.Design, Setting, and ParticipantsThis randomized, open-label, noninferiority clinical trial enrolled adults (aged ≥18 years) with chronic or acute coronary syndrome and angiographically confirmed native coronary artery stenosis requiring PCI. Patients were enrolled in 6 cardiac centers in Korea from February 23, 2017, to August 23, 2021, and follow-up occurred through August 25, 2022. All principal analyses were performed according to the intention-to-treat principle.InterventionsAfter successful guidewire crossing of the first target lesion, patients were randomized in a 1:1 ratio to receive either QCA- or IVUS-guided PCI.Main Outcomes and MeasuresThe primary outcome was target lesion failure at 12 months, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. The trial was designed assuming an event rate of 8%, with the upper limit of the 1-sided 97.5% CI of the absolute difference in 12-month target lesion failure (QCA-guided PCI minus IVUS-guided PCI) to be less than 3.5 percentage points for noninferiority.ResultsThe trial included 1528 patients who underwent PCI with QCA guidance (763; mean [SD] age, 64.1 [9.9] years; 574 males [75.2%]) or IVUS guidance (765; mean [SD] age, 64.6 [9.5] years; 622 males [81.3%]). The post-PCI mean (SD) minimum lumen diameter was similar between the QCA- and IVUS-guided PCI groups (2.57 [0.55] vs 2.60 [0.58] mm, P = .26). Target lesion failure at 12 months occurred in 29 of 763 patients (3.81%) in the QCA-guided PCI group and 29 of 765 patients (3.80%) in the IVUS-guided PCI group (absolute risk difference, 0.01 percentage points [95% CI, –1.91 to 1.93 percentage points]; hazard ratio, 1.00 [95% CI, 0.60-1.68]; P = .99). There was no difference in the rates of stent edge dissection (1.2% vs 0.7%, P = .25), coronary perforation (0.2% vs 0.4%, P = .41), or stent thrombosis (0.53% vs 0.66%, P = .74) between the QCA- and IVUS-guided PCI groups. The risk of the primary end point was consistent regardless of subgroup, with no significant interaction.Conclusions and RelevanceFindings of this randomized clinical trial indicate that QCA and IVUS guidance during PCI showed similar rates of target lesion failure at 12 months. However, due to the lower-than-expected rates of target lesion failure in this trial, the findings should be interpreted with caution.Trial RegistrationClinicalTrials.gov Identifier: NCT02978456

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Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation

Cited by 462 publications

References 27 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

Associations of coronary plaque characteristics by integrated backscatter intravascular ultrasound with detectability of vessel external elastic lamina using optical frequency domain imaging in human coronary arteries: A sub‐analysis of the MISTIC‐1 trial

Quantitative Coronary Angiography vs Intravascular Ultrasonography to Guide Drug-Eluting Stent Implantation

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