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

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 OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1015 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 endpoint 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/1.73m²), 391 patients (38.5%) with moderate CKD (60> eGFR >=30 mL/min/1.73m²), and 96 patients (9.5%) with severe CKD (eGFR <30 mL/min/1.73m² or hemodialysis). The rate of meeting OPTIVUS criteria was not different across the 3 groups. The cumulative 1-year incidence of the primary endpoint 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 endpoint (HR, 2.42; 95%CI, 1.30-4.25; P=0.01), while the risk of moderate CKD relative to no CKD was not significant for the primary endpoint (HR, 0.97; 95%CI, 0.61-1.53; P=0.88). In conclusion, among 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, while 1-year clinical outcomes were not different between patients without CKD and with moderate CKD.