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

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Limited data exist on clinical outcomes following intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and left ventricular (LV) dysfunction.
• Left ventricular (LV) dysfunction is a significant factor impacting cardiac health and patient prognosis.

Purpose of the Study:

• To evaluate the clinical outcomes of multivessel IVUS-guided PCI in patients with and without left ventricular (LV) dysfunction.
• To determine if LV dysfunction is associated with adverse clinical events after complex PCI.

Main Methods:

• Prospective, multicenter, single-arm trial (OPTIVUS-Complex PCI study) including 1,010 patients undergoing multivessel IVUS-guided PCI.
• Patients were categorized based on LV ejection fraction (LVEF): preserved (>50%), moderate (35-50%), and severe (≤35%).
• Primary endpoint: composite of death, myocardial infarction, stroke, revascularization, or heart failure hospitalization at 1 year.

Main Results:

• The 1-year incidence of the primary endpoint was 9.5% in preserved LV function, 18.9% in moderate LV dysfunction, and 17.1% in severe LV dysfunction (log-rank P<0.001).
• Adjusted analysis showed a significantly higher risk for the primary endpoint in moderate LV dysfunction (HR, 1.71; P=0.02) and a numerically higher risk in severe LV dysfunction (HR, 1.52; P=0.23) compared to preserved LV function.
• IVUS-guided PCI in multivessel disease demonstrated worse outcomes in patients with LV dysfunction.

Conclusions:

• One-year clinical outcomes after multivessel IVUS-guided PCI were worse in patients with left ventricular (LV) dysfunction compared to those with preserved LV function.
• LV dysfunction is an important predictor of adverse events in patients undergoing complex PCI.
• These findings highlight the need for careful consideration of LV function in risk stratification and treatment planning for patients undergoing multivessel PCI.