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

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2024-12-17 DOI:10.1016/j.amjcard.2024.12.020

Ko Yamamoto MD , Hiroki Shiomi MD , Ryusuke Nishikawa MD , Takeshi Morimoto MD, MPH , Akiyoshi Miyazawa MD , Toru Naganuma MD , Satoru Suwa MD , Takanari Fujita MD , Takenori Domei MD , Shojiro Tatsushima MD , Yukihiro Hamaguchi MD , Yuji Nishimoto MD , Kensho Matsuda MD , Yohei Takayama MD , Jun Kuribara MD , Hidekuni Kirigaya MD , Kohei Yoneda MD , Masataka Shigetoshi MD , Takafumi Yokomatsu MD , Kazushige Kadota MD , Takeshi Kimura MD

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Abstract

There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and chronic kidney disease (CKD). The Optimal Intravascular Ultrasound (OPTIVUS)-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,015 patients who underwent multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between patients with and without CKD. The primary end point was a composite of death, myocardial infarction, stroke, or any coronary revascularization. There were 528 patients (52.0%) without CKD (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m²), 391 patients (38.5%) with moderate CKD (60 >eGFR ≥30 ml/min/1.73 m²), and 96 patients (9.5%) with severe CKD (eGFR <30 ml/min/1.73 m² or hemodialysis). The rate of meeting OPTIVUS criteria was not different across the 3 groups. The cumulative 1-year incidence of the primary end point was 9.1%, 9.0%, and 22.1% in patients without CKD, with moderate CKD, and with severe CKD, respectively (log-rank p <0.001). After adjusting confounders, the higher risk of severe CKD relative to no CKD remained significant for the primary end point (hazard ratio 2.42, 95% confidence interval 1.30 to 4.25, p = 0.01), whereas the risk of moderate CKD relative to no CKD was not significant for the primary end point (hazard ratio 0.97, 95% confidence interval 0.61 to 1.53, p = 0.88). In conclusion, in patients who underwent multivessel IVUS-guided PCI, and were managed with contemporary clinical practice, 1-year clinical outcomes were worse in patients with severe CKD, whereas 1-year clinical outcomes were not different between patients without CKD and with moderate CKD.

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多血管疾病和慢性肾病患者的最佳血管内超声引导经皮冠状动脉介入治疗。

关于多血管疾病和慢性肾脏疾病（CKD）患者在血管内超声（IVUS）引导下经皮冠状动脉介入治疗（PCI）的临床结果的数据缺乏。OPTIVUS- complex PCI研究多血管队列是一项前瞻性多中心单臂试验，纳入1015名接受多血管ivus引导的PCI治疗的患者，包括左冠状动脉前降支靶，目的是满足预先指定的OPTIVUS标准，以达到最佳支架扩张。我们比较了CKD患者和非CKD患者的临床结果。主要终点是死亡、心肌梗死、中风或任何冠状动脉血运重建术的复合终点。无CKD患者528例（52.0%）（估计肾小球滤过率[eGFR] >=60 mL/min/1.73m2），中度CKD患者391例（38.5%）（60> eGFR >=30 mL/min/1.73m2），重度CKD患者96例（9.5%）（eGFR 2或血液透析）。三组患者的OPTIVUS标准满意率无差异。在无CKD、中度CKD和重度CKD患者中，主要终点的1年累积发生率分别为9.1%、9.0%和22.1% (log-rank P

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.