Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting

Self Cite

Objectives: to test the safety and efficacy of intravascular imaging and specifically optical coherence tomography (OCT) as a diagnostic tool for left main angioplasty and analyze the mid-term outcome accordingly.Background: Clinical data and international guidelines recommend the use of intravascular imaging ultrasound (IVUS) to guide left main (LM) angioplasty. Despite early experience using OCT in this setting is encouraging, the evidence supporting its use is still limited.Methods: ROCK II is a multicenter, investigator-driven, retrospective European study to compare the performance of IVUS and OCT versus angiography in patients undergoing distal-LM stenting. The primary study endpoint was target-lesion failure (TLF) including cardiac death, target-vessel myocardial infarction and target-lesion revascularization. We designed this study hypothesizing the superiority of intravascular imaging over angiographic guidance alone, and the non-inferiority of OCT versus IVUS.Results: A total of 730 patients, 377 with intravascular-imaging guidance (162 OCT, 215 IVUS) and 353 with angiographic guidance, were analyzed. The one-year rate of TLF was 21.2% with angiography and 12.7% with intravascular-imaging (p = 0.039), with no difference between OCT and IVUS (p = 0.26). Intravascular-imaging was predictor of freedom from TLF (HR 0.46; 95% CI 0.23-0.93: p = 0.03). Propensity-score matching identified three groups of 100 patients each with no significant differences in baseline characteristics. The one-year rate of TLF was 16% in the angiographic, 7% in the OCT and 6% in the IVUS group, respectively (p = 0.03 for IVUS or OCT vs.

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography, intravascular ultrasound or angiography guidance for distal left main coronary stenting. The ROCK cohort II study

Cortese

Łanocha

Ielasi

et al. 2021

Self Cite

“…A control group including patients with angiography‐guided PCI from a large registry was selected for comparison and follow‐up was conducted after 12 months. The primary end‐point (a composite of cardiac death, LM‐related infarction and LM revascularization) was significantly higher when angiography was the sole method for PCI guidance, thus the authors concluded that IVUS guidance of LM stenting provides prognostic benefit, especially when predefined optimization criteria are used 29 . An important meta‐analysis of 4592 patients from seven clinical studies validated these results, showing how IVUS guidance was associated with a significant reduction in MACE (relative reduction [RR] 95% confidence interval [CI] 0.61; 95% CI 0.53−0.70; p < 0.001), all‐cause death (RR 0.55; 95% CI 0.42 to 0.71; p < 0.001), cardiac death (RR 0.45; 95% CI 0.32−0.62; p < 0.001), myocardial infarction (RR 0.66; 95% CI 0.55−0.80; p < 0.001), and stent thrombosis (RR 0.48; 95% CI 0.27−0.84; p = 0.01) compared with angiographic guidance 30 …”

Section: Introductionmentioning

confidence: 99%

Intravascular imaging for left main stem assessment: An update on the most recent clinical data

Cortese

Piraino

Gentile

et al. 2022

Left main (LM) stem has different structural and anatomical characteristics compared to all of the other segments of the coronary tree, thus its management through percutaneous coronary intervention (PCI) is a challenge and is associated with worse clinical outcome and higher need for revascularization as compared to other lesion settings. Intravascular imaging, by means of intravascular ultrasound (IVUS) or optical coherence tomography (OCT), is an important tool for LM PCI guidance, aiming at improving the immediate performance and the long term outcome of this procedure. Following current guidelines and recent scientific findings, IVUS becomes important to firstly assess, and finally evaluate the result of LM stenting, according to the experience and preferences of the operator. The role of OCT still remains to be defined, but recent data is shedding light also on this imaging technique. The aim of this review is to highlight the latest scientific advancements regarding intravascular imaging in LM coronary artery disease.

“…For instance, one registry including 46,095 atherectomy‐directed PCI cases found IVUS was used in 10.4% of the cases 32 . Furthermore, IVUS has had superior outcomes compared with angiography‐alone in complex lesions including LM stenosis 33 . The iOPEN Complex trial examined lesions beyond just LM stenosis, including Type C lesions, in‐stent restenosis, long lesions, bifurcations, severe calcifications and CTOs in addition and found IVUS utilization compared to angiography‐alone, conferred lower rates of MACE at 1 year 34 …”

Section: Discussionmentioning

confidence: 99%

Impact of intracoronary imaging on in‐hospital mortality and 30‐day readmission rates following percutaneous coronary intervention: A nationwide readmissions database analysis

Lazkani

Tripathi

Dattilo

2020

Background: Percutaneous coronary intervention (PCI) is well established for the treatment of obstructive coronary artery disease. This study was performed to assess the impact of in-hospital mortality and 30-day readmission with intracoronary imaging as an adjunct to baseline coronary angiography. Methods:The study was derived from the Healthcare Cost and Utilization Project's National Readmission Database (NRD) of 2016, sponsored by the Agency for Healthcare Research and Quality. Patients who underwent PCI were identified using appropriate ICD-10 codes. Study population was further subcategorized into 2 PCI arms: intravascular imaging (''imaging'' group) and fluoroscopy guided (''angiography'' group). Primary endpoints were 30-day readmissions and in-hospital mortality. Secondary endpoints were length of stay, cost of care, predictors of 30-day readmission and in-hospital mortality in PCI related hospitalizations.Results: We identified in total 188,368 index admissions, with 12,379 patients in the "imaging-guided" group and 175,989 in the "angiography-alone" group. There were no differences in 30-day readmissions between both groups (10.8% in both arms, p = .788). However, in-hospital mortality carried a statistically significant reduction with use of imaging-guided PCI (1.72% vs 2.24%, p = .004). The median length of stay was longer in the imaging-guided arm (3 vs. 2 days, p < .001), associated with larger median total hospital costs ($32,123 USD vs. $25,162 USD, p < .001). The strongest predictor of in-hospital mortality in both univariate and multivariate analysis was having an existing coagulopathy. Conclusion:The results of this study did not confer benefit with regards to 30-day hospital readmission rates when utilizing intracoronary imaging versus angiographyalone in percutaneous coronary intervention, but did suggest there may be an association between the use of intracoronary imaging and improved in-hospital mortality.In addition, resource utilization was higher in the intra-coronary imaging arm of the study.