Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease
Ko Yamamoto, Hiroki Shiomi, Takeshi Morimoto, Hiroki Watanabe, Akiyoshi Miyazawa, Kyohei Yamaji, Masanobu Ohya, Sunao Nakamura, Satoru Mitomo, Satoru Suwa, Takenori Domei, Shojiro Tatsushima, Koh Ono, Hiroki Sakamoto, Kiyotaka Shimamura, Masataka Shigetoshi, Ryoji Taniguchi, Yuji Nishimoto, Hideki Okayama, Kensho Matsuda, Takafumi Yokomatsu, Masahiro Muto, Ren Kawaguchi, Koichi Kishi, Mitsuyoshi Hadase, Tsutomu Fujita, Yasunori Nishida, Masami Nishino, Hiromasa Otake, Kengo Tanabe, Mitsuru Abe, Kiyoshi Hibi, Kazushige Kadota, Kenji Andò, Takeshi Kimura
Abstract
Background: Intravascular ultrasound (IVUS) was only rarely used in landmark trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel disease. Objectives: The authors aimed to evaluate clinical outcomes after optimal IVUS-guided PCI in patients undergoing multivessel PCI. Methods: The OPTIVUS (OPTimal IntraVascular UltraSound)-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified criteria (OPTIVUS criteria: minimum stent area > distal reference lumen area [stent length ≥28mm], and minimum stent area >0.8 × average reference lumen area [stent length <28mm]) for optimal stent expansion. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) (death/myocardial infarction/stroke/any coronary revascularization). The predefined performance goals were derived from the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome study in Kyoto) PCI/CABG registry cohort-2 fulfilling the inclusion criteria in this study. Results: 0.001), and which was numerically lower than the predefined CABG performance goal of 13.8%. The cumulative 1-year incidence of the primary endpoint was not significantly different regardless of meeting or not meeting OPTIVUS criteria. Conclusions: Contemporary PCI practice conducted in the OPTIVUS-Complex PCI study multivessel cohort was associated with a significantly lower MACCE rate than the predefined PCI performance goal, and with a numerically lower MACCE rate than the predefined CABG performance goal at 1 year.