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Comparison of the OPTIVUS-Complex PCI Multivessel Cohort With the Historical CREDO-Kyoto Registry Cohort-3
Ko Yamamoto1, Hiroki Shiomi1, Takeshi Morimoto2
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine.
Insights
Optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) significantly improved outcomes for multivessel disease patients compared to standard PCI or coronary artery bypass grafting (CABG) at one year.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Clinical Trials
Background:
- Limited data exists on optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) versus standard PCI or coronary artery bypass grafting (CABG) for multivessel disease.
- Multivessel coronary artery disease requires effective revascularization strategies.
Purpose of the Study:
- To evaluate the effectiveness of optimal IVUS-guided PCI against historical PCI and CABG controls in patients with multivessel disease.
- To assess the impact of achieving optimal stent expansion using IVUS on clinical outcomes.
Main Methods:
- Prospective, multicenter, single-arm study (OPTIVUS-Complex PCI) of 1,021 patients undergoing IVUS-guided multivessel PCI.
- Propensity score matching with historical control groups from the CREDO-Kyoto registry (1,565 PCI, 899 CABG).
- Primary endpoint: composite of death, myocardial infarction, stroke, or any coronary revascularization at 1 year.
Main Results:
- In propensity score-matched cohorts, the OPTIVUS group (926 patients) showed significantly lower 1-year event rates than historical PCI controls (926 patients): 10.4% vs. 23.3% (P<0.001).
- The OPTIVUS group (436 patients) also had significantly lower 1-year event rates than historical CABG controls (436 patients): 11.8% vs. 16.5% (P=0.02).
Conclusions:
- Optimal IVUS-guided PCI, adhering to specific expansion criteria, demonstrated superior 1-year clinical outcomes.
- This approach proved more effective than both historical standard PCI and historical CABG for multivessel disease patients.
Background:
There is a paucity of data on the effect of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with standard PCI or coronary artery bypass grafting (CABG) in patients with multivessel disease.
Methods And Results:
The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI including the left anterior descending coronary artery using IVUS aiming to meet the prespecified criteria for optimal stent expansion. We conducted propensity score matching analyses between the OPTIVUS group and historical PCI or CABG control groups from the CREDO-Kyoto registry cohort-3 (1,565 and 899 patients) fulfilling the inclusion criteria for this study. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. In the propensity score-matched cohort (OPTIVUS vs. historical PCI control: 926 patients in each group; OPTIVUS vs. historical CABG control: 436 patients in each group), the cumulative 1-year incidence of the primary endpoint was significantly lower in the OPTIVUS group than in the historical PCI control group (10.4% vs. 23.3%; log-rank P<0.001) or the historical CABG control group (11.8% vs. 16.5%; log-rank P=0.02).
Conclusions:
IVUS-guided PCI targeting the OPTIVUS criteria combined with contemporary clinical practice was associated with superior clinical outcomes at 1 year compared with not only the historical PCI control, but also the historical CABG control.
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