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Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease and

Ko Yamamoto1, Hiroki Shiomi2, Takeshi Morimoto3

  • 1Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

The American Journal of Cardiology
|May 13, 2024
PubMed

Insights

Patients with diabetes undergoing complex multivessel percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) have similar 1-year outcomes to those without diabetes. This study highlights comparable results for this high-risk group when managed with optimal stent expansion criteria.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Data on clinical outcomes for diabetic patients undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for multivessel disease is scarce.
  • Optimal stent expansion is crucial for successful PCI outcomes, particularly in complex cases.

Purpose of the Study:

  • To compare 1-year clinical outcomes between diabetic and non-diabetic patients who underwent multivessel PCI guided by IVUS.
  • To assess the impact of diabetes on outcomes in patients treated with IVUS-guided PCI aiming for optimal stent expansion.

Main Methods:

  • Prospective, multicenter, single-arm trial (Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention study).
  • 1,021 patients with multivessel disease underwent IVUS-guided PCI, including the left anterior descending artery.
  • Patients were stratified into diabetic (n=560) and non-diabetic (n=461) groups, with outcomes compared based on the prespecified OPTIVUS criteria.

Main Results:

  • The rate of achieving optimal stent expansion (OPTIVUS criteria) was similar between diabetic and non-diabetic groups (61.2% vs. 60.7%, p=0.83).
  • Diabetic patients had more complex coronary artery disease, evidenced by higher stent utilization and longer stent lengths.
  • The primary endpoint (composite of death, myocardial infarction, stroke, or revascularization) at 1 year was comparable: 10.8% in diabetics vs. 9.8% in non-diabetics (log-rank p=0.65).
  • Adjusted analysis showed no significant difference in the primary endpoint risk between groups (HR 0.97, 95% CI 0.65-1.44, p=0.88).

Conclusions:

  • In patients undergoing multivessel IVUS-guided PCI with contemporary management, diabetes does not appear to be associated with significantly different 1-year clinical outcomes.
  • Achieving optimal stent expansion with IVUS is feasible and yields similar results in both diabetic and non-diabetic patients with multivessel disease.
  • These findings suggest that IVUS-guided PCI can effectively manage complex multivessel disease in diabetic patients, leading to comparable outcomes to their non-diabetic counterparts.

Keywords:
diabetesdrug-eluting stentintravascular ultrasoundpercutaneous coronary intervention

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