Impact of Intravascular Ultrasound on Outcomes Following PErcutaneous Coronary InterventioN in Complex Lesions (iOPEN Complex Study)

Shlofmitz, Evan

Impact of Intravascular Ultrasound on Outcomes Following PErcutaneous Coronary InterventioN in Complex Lesions (iOPEN Complex Study)

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Evan Shlofmitz, D.O. , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Rebecca Torguson , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Cheng Zhang, PhD , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Paige E Craig , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Nauman Khalid, MD , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Yuefeng Chen, MD, PhD , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Toby Rogers, MD , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Robert A Gallino, M.D. , Cardiology Associates, Washington, DC

Itsik Ben-Dor, MD , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Nelson L. Bernardo, M.D., FSCAI , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Hector M Garcia-Garcia, MD, PhD , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Lowell F. Satler, M.D., FSCAI , Washington Cardiology Center, Washington, DC

Ron Waksman, M.D., FSCAI , MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC

Background:
Clinical data supports the use of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) to be associated with a reduction in recurrent events after PCI. Nonetheless, global utilization of IVUS remains low. We hypothesize that for the revascularization of complex lesions, IVUS will be associated with improved outcomes.

Methods:
All patients treated with PCI at a single-center from 2003-2016 with a complex lesion were included and stratified by use of IVUS. Complex lesions were defined as including one or more of the following lesion types: American College of Cardiology/American Heart Association (ACC/AHA) Type C Lesions, in-stent restenosis, long lesions, bifurcations, severe calcification, left main lesions and chronic total occlusions (CTO). The primary endpoint was the rate of major adverse cardiac events (MACE) at 1-year follow-up, defined as the composite of all-cause mortality, q-wave myocardial infarction and target vessel revascularization. Inverse probability of treatment weighting (IPTW) was used for the adjusted analysis for IVUS usage.

Results:
6,855 patients were included in the final analysis, of whom 67.3% had IVUS and 32.7% had angiography alone. The primary endpoint occurred in 13.4% of patients treated with IVUS and 18.3% of patients treated without IVUS (p<0.001). IPTW adjusted 1-year MACE rates are presented with risk reduction (RR) by lesion type [Figure 1].

Conclusions:
The use of IVUS is associated with decreased major adverse cardiac events at 1-year following PCI in patients with complex lesions. The impact of IVUS in this patient population may be greater than with an all-comer population.