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

Ko Yamamoto1, Hiroki Shiomi2, Ryusuke Nishikawa2

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

Circulation Reports
|April 11, 2025
PubMed

Insights

Clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) are worse for patients with left ventricular (LV) dysfunction. This study analyzed 1,010 patients, finding increased risks for those with moderate to severe LV dysfunction.

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.
Abstract

Keywords:
Drug-eluting stentsIntravascular ultrasoundLeft ventricular ejection fractionPercutaneous coronary intervention

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