Impact of Intravascular Ultrasound on Chronic Total Occlusion Percutaneous Revascularization.
Cardiovasc Revasc Med
; 33: 32-40, 2021 12.
Article
en En
| MEDLINE
| ID: mdl-33461936
ABSTRACT
AIM:
We sought to investigate the impact of IVUS use on chronic total occlusion (CTO) PCI using data from a contemporary registry of consecutive patients and applying a propensity score matching analysis. METHODS ANDRESULTS:
We evaluated 514 successful CTO-PCIs, median age 67 years (IQR 58-73), 83.5% males. IVUS-guided PCI was performed in 184 (35.8%) of cases. After using 11 propensity matching score analysis, two groups of 182 patients each (IVUS-guided vs. angiography-guided CTO-PCI group) were produced to form the study population. In the IVUS-guided group the median maximum stent diameter was larger and the median total stented segment was longer compared to the angiography-guided group [(3.5 mm, IQR 3.0-4.0 vs. 3.2 mm, IQR 3.0-3.5, p < 0.001) and (60.0 mm, IQR 38.0-91.3 vs. 38.0 mm, IQR 32.0-70.5, p < 0.001), respectively]. In the IVUS-guided group, retrograde recanalization was more frequently encountered compared to the angiography-guided PCI group (30.2% vs. 20.9%, p = 0.04). Procedural time was significantly longer in the IVUS-guided group, without any difference in fluoroscopy time, radiation dose and contrast volume. Multivariate linear regression analysis showed that IVUS use was the strongest independent factor associated with larger maximum diameter stents (p < 0.001) and a strong independent predictor for total stented segment length during CTO-PCI (p < 0.001). Up to 8 years follow-up, there was no difference in the incidence of the composite endpoint of all-cause death, cardiac death, myocardial infarction and target vessel revascularization between the IVUS-guided PCI and the angiography-guided PCI groups (hazard ratio 13.7% vs. 15.9%, respectively, log-rank p = 0.67, median follow-up time 49.0 months, IQR 33.0-67.0).CONCLUSIONS:
Use of IVUS in CTO-PCI was associated with larger stent diameter and longer stented segments. Despite more frequent use of IVUS in retrograde CTO-PCI, there was no difference in long-term adverse events between IVUS and angiography CTO-PCI groups; nevertheless, the study was not powered to assess clinical outcomes.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Oclusión Coronaria
/
Stents Liberadores de Fármacos
/
Intervención Coronaria Percutánea
Tipo de estudio:
Prognostic_studies
Límite:
Aged
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Cardiovasc Revasc Med
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Grecia