Clinical outcomes of post-stent intravascular ultrasound examination for chronic total occlusion intervention with drug-eluting stents

Osung Kwon, Pil Hyung Lee, Seung Whan Lee, Emmanouil S. Brilakis, Jong Young Lee, Yong Hoon Yoon, Kyusup Lee, Hanbit Park, Soo Jin Kang, Young Hak Kim, Cheol Whan Lee, Seong Wook Park

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Few studies have evaluated intravascular ultrasound (IVUS) use in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Aims: In CTO-PCI, we aimed to (1) evaluate the clinical benefits of performing post-stent IVUS in preventing adverse clinical events, and (2) identify IVUS parameters and cut-off values for prediction of target lesion revascularisation (TLR)/reocclusion. Methods: A total of 1, 077 patients with 1, 077 CTO lesions treated with drug-eluting stents (DES) were included. Clinical outcomes during a median follow-up of 6.3 years were compared between subjects with and those without post-stent IVUS using the inverse probability weighting method. Results: Of 1, 077 patients, post-stent IVUS was performed in 838 (77.8%) cases while in the remaining 239 (22.2%) cases it was not. In the weighted population, the risk of TLR/reocclusion was significantly lower in subjects with post-stent IVUS (9.6% vs 18.9%, hazard ratio [HR] 0.54, 95% confidence interval [CI]: 0.34-0.86, p=0.01), compared with those without post-stent IVUS. Cox regression analysis showed that minimal stent area (MSA) measured by IVUS was the only parameter independently associated with TLR/reocclusion (HR 0.78, 95% CI: 0.64-0.95; p=0.01) and the optimal MSA cut-off value was 4.9 mm2 for prediction of TLR/reocclusion (area under the curve=0.632, p=0.001). Conclusions: In CTO-PCI with DES, post-stent IVUS evaluation was associated with a lower risk of TLR/reocclusion. The final MSA was independently associated with TLR/reocclusion with a cut-off value of 4.9 mm2.

Original languageEnglish (US)
Pages (from-to)E639-E646
JournalEuroIntervention
Volume17
Issue number8
DOIs
StatePublished - Oct 2021
Externally publishedYes

Keywords

  • Chronic coronary total occlusion
  • Drug-eluting stent
  • Intravascular ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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