Outcomes With Intravascular Ultrasound and Optical Coherence Tomography Guidance in Percutaneous Coronary
Shilpkumar Arora1, Rahul Jaswaney2, Tasveer Khawaja3
1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio.
Insights
Intracoronary imaging using intravascular ultrasound (IVUS) and optical coherence tomography (OCT) significantly reduces major adverse cardiac events and mortality in patients undergoing percutaneous coronary intervention (PCI). These advanced imaging techniques improve patient outcomes in real-world practice.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) is a cornerstone in treating complex coronary lesions.
- Intracoronary imaging modalities like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are increasingly utilized.
- Real-world data on the comparative effectiveness of IVUS and OCT in PCI is crucial.
Purpose of the Study:
- To evaluate the impact of IVUS and OCT guidance on clinical outcomes in a large cohort of PCI patients.
- To compare the rates of major adverse cardiac events (MACE) and other secondary outcomes between patients who received IVUS or OCT guidance versus those who did not.
- To assess the real-world effectiveness of these intracoronary imaging techniques.
Main Methods:
- Retrospective cohort study utilizing the Nationwide Readmissions Database (2017-2019).
- Inclusion of 1,118,475 patients undergoing PCI, with identification of IVUS and OCT use via ICD codes.
- Multivariate Cox proportional hazard regression analysis adjusted for confounders to assess outcomes.
Main Results:
- IVUS guidance (7.7% of PCIs) was associated with significantly lower MACE (6.5% vs 7.6%) and improved secondary outcomes including NACEs, all-cause mortality, MI readmission, and stroke admission.
- OCT guidance (0.5% of PCIs) also demonstrated significantly lower MACE (4.4% vs 7.6%) and reduced NACEs and all-cause mortality.
- No significant differences in emergency revascularization were observed for IVUS, and no significant differences in MI, stroke, or emergency revascularization for OCT.
Conclusions:
- IVUS and OCT guidance during PCI are associated with significantly reduced rates of major adverse cardiac events, morbidity, and mortality in a large, real-world patient population.
- These findings support the routine use of intracoronary imaging in complex PCI procedures.
- Further research may explore specific indications and optimal utilization of IVUS and OCT.
Abstract:
Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). This retrospective cohort study identified 1,118,475 patients with PCI from the Nationwide Readmissions Database from 2017 to 2019. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were identified with appropriate International Classification of Diseases, Tenth Revision codes. The primary outcome was major adverse cardiac events. The secondary outcomes include net adverse clinical events (NACEs), all-cause mortality, myocardial infarction (MI) readmission, admission for stroke, and emergency revascularization. The multivariate Cox proportional hazard regression was used to adjust for demographic and co-morbid confounders. Of 1,118,475 PCIs, 86,140 (7.7%) used IVUS guidance and 5,617 (0.5%) used OCT guidance. The median follow-up time was 184 days. The primary outcome of major adverse cardiac events was significantly lower for the IVUS (6.5% vs 7.6%; hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.86 to 0.91, p <0.001) and OCT (4.4% vs 7.6%; HR 0.69, 95% CI 0.61 to 0.79, p <0.001) groups. IVUS was associated with significantly lower rates of NACEs (8.4% vs 9.4%; HR 0.92, 95% CI 0.89 to 0.94, p <0.001), all-cause mortality (3.5% vs 4.3%; HR 0.85, 95% CI 0.82 to 0.88, p <0.001), readmission for MI (2.7% vs 3.0%; HR 0.95, 95% CI 0.91 to 0.99, p = 0.012), and admission for stroke (0.5% vs 0.6%; HR 0.86, 95% CI 0.78 to 0.95, p = 0.002). OCT was associated with significantly lower rates of NACEs (6.6% vs 9.4%; HR 0.81, 95% CI 0.73 to 0.89, p <0.001) and all-cause mortality (1.8% vs 4.3%; HR 0.51, 95% CI 0.42 to 0.63, p <0.001). Emergency revascularization was not significantly different with IVUS guidance. Readmission for MI, stroke, and emergency revascularization were not significantly different with OCT guidance. A subgroup analysis of patients with ST-elevation MI and non-ST-elevation MI showed similar results. In conclusion, the use of IVUS and OCT guidance with PCI were associated with significantly lower rates of morbidity and mortality in real-world practice.
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