Intravascular Imaging-Guided Percutaneous Coronary Intervention in Patients With End-Stage Renal Disease on
Chia-Pin Lin1,2, Fu-Chih Hsiao1, Ying-Chang Tung1
1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Insights
Intravascular imaging-guided percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) or intravascular ultrasound (IVUS) showed comparable clinical outcomes for end-stage renal disease (ESRD) patients. The use of IVI-guided PCI has increased in Taiwan for both general and ESRD populations.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- End-stage renal disease (ESRD) patients face elevated cardiovascular disease risks.
- Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) offers improved outcomes over angiography alone.
- Clinical outcomes of IVI-guided PCI in ESRD patients require further investigation.
Purpose of the Study:
- To compare clinical outcomes of OCT-guided vs. IVUS-guided PCI in ESRD patients.
- To analyze trends in IVI-guided PCI utilization in Taiwan.
Main Methods:
- Propensity-score matching of ESRD patients on maintenance dialysis undergoing OCT- or IVUS-guided PCI (2015-2021).
- Primary outcome: composite cardiovascular events (coronary revascularization, cardiovascular death, acute myocardial infarction).
Main Results:
- IVI use increased significantly in Taiwan, guiding 27.5% of PCIs in ESRD patients by 2021.
- After matching, OCT and IVUS groups showed comparable primary outcome incidence (42.1 vs. 47.6 events per 100 person-years).
- Subgroup analyses and individual outcome components did not reveal significant differences.
Conclusions:
- PCI and IVI-guided procedures show a rising trend in Taiwan for both general and ESRD populations.
- OCT- and IVUS-guided PCI yield comparable clinical outcomes in ESRD patients on maintenance dialysis.
Background:
Patients with end-stage renal disease (ESRD) are at a higher risk of cardiovascular diseases. Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) or intravascular ultrasound (IVUS) has been shown to result in better clinical outcomes than angiography guidance. Nevertheless, the clinical outcomes of IVI-guided PCI in ESRD patients remain uncertain.
Objectives:
This study aimed to compare the clinical outcomes of OCT- and IVUS-guided PCIs in ESRD patients and to report the trend of IVI-guided PCI in Taiwan.
Methods:
Patients with ESRD on maintenance dialysis, who underwent OCT- or IVUS-guided PCI from 2015 to 2021, were compared by propensity-score matching. The primary outcome was composite cardiovascular outcomes, including coronary revascularization, cardiovascular death, and acute myocardial infarction.
Results:
In 2021, IVI was used to guide PCIs in 27% (15,613 of 57,845) of general and 27.5% (1,754 of 6,387) of ESRD patients. Among 4,759 eligible ESRD patients, 443 and 4,316 patients underwent OCT- and IVUS-guided PCIs, respectively. After matching, the incidence of the primary outcome was comparable between the OCT and IVUS groups (42.1 [95% CI: 36.2-48.0] vs 47.6 [95% CI: 43.0-52.2] events per 100 person-years; HR: 0.88; 95% CI: 0.74-1.06). The results were similar for all components of the primary outcome and in subgroup analyses.
Conclusions:
The number of PCI- and IVI-guided procedures has progressively increased in the past decade in Taiwan in both the general and ESRD populations. Among ESRD patients on maintenance dialysis, the clinical outcomes were comparable between OCT- and IVUS-guided PCI.
