Single-Session Versus Staged Multivessel Optimal IVUS-Guided PCI in Patients With CCS or NSTE-ACS
Ko Yamamoto1, Hiroki Shiomi2, Takeshi Morimoto2
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
JACC. Asia
|August 24, 2023
Summary
Single-session and staged multivessel intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) showed similar outcomes in patients with chronic coronary syndrome or non-ST-elevation acute coronary syndrome. This study provides valuable insights into optimal PCI strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- No prior studies compared single-session versus staged multivessel IVUS-guided PCI for chronic or non-ST-elevation acute coronary syndromes.
- Intravascular ultrasound (IVUS) is crucial for optimizing stent expansion during PCI.
Purpose of the Study:
- To compare the clinical outcomes of single-session versus staged multivessel IVUS-guided PCI in patients with chronic coronary syndrome (CCS) or non-ST-elevation acute coronary syndrome (NSTE-ACS).
Main Methods:
- A prospective, multicenter, single-arm trial (OPTIVUS-Complex PCI study) enrolled 1,021 patients undergoing multivessel PCI with IVUS guidance.
- Patients were categorized into single-session (n=246) or staged (n=775) PCI groups.
- The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization at 1 year.
Main Results:
- Staged PCI was more common and associated with more complex coronary anatomy (e.g., 3-vessel disease, chronic total occlusions).
- PCI success rates, procedural complications, and achievement of optimal stent expansion were similar between groups.
- The 1-year cumulative incidence of the primary endpoint did not differ significantly between single-session (9.0%) and staged (10.8%) PCI groups (P=0.42).
Conclusions:
- Single-session and staged multivessel IVUS-guided PCI demonstrate comparable 1-year clinical outcomes in patients with CCS or NSTE-ACS.
- The choice between single-session and staged PCI may depend on patient complexity and procedural considerations, with similar safety and efficacy observed.
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