Background:
Intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation is associated with improved clinical outcomes in complex lesions. However, it still remains controversial that routine IVUS guidance could beneficial to patients with chronic kidney disease (CKD).
Methods:
This study aimed to investigate the impacts of IVUS-guided DES implantation on patients with CKD based on the database from ULTIMATE trial.
Results:
eGFR was available in 1443 patients, with mean eGFR 81.41±28.92 ml/min/1.73 m2, of whom 723 in the IVUS guidance group and 720 in the angiography guidance group. Finally, CKD was present in 349 (24.2%) patients. At 12 months, the TVF in the CKD group was 7.2%, significantly higher than 3.2% in no CKD group (HR 2.30, 95% CI: 1.38-3.84; p = 0.001), mainly driven by increased risk of cardiac death (2.9% vs. 0.5%, p<0.001) in CKD patients . Moreover, there were 25 TVFs in CKD patients, with 7 (3.9%) in the IVUS group and 18 (10.7%) in the angiography group (HR 0.35, 95% CI: 0.15-0.84; p=0.01)(Figure 1), while 35 TVFs occurred in patients without CKD, with 14 (2.6%) in the IVUS group and 21 (3.8%) in the angiography group (HR 0.67, 95% CI 0.34-1.32; p=0.25; p for interaction=0.24). The reduced risk of TVF in the IVUS group for CKD patients was mainly driven by the lower risk of TVMI (0.6% vs. 3.6%, borderline p = 0.05) and TVR (1.1% vs. 4.7, p = 0.04).
Conclusions:
The present study demonstrated that CKD patients undergoing DES implantation were associated with a higher risk of TVF during 12 months of follow-up. More importantly, the risk of TVF in CKD patients could be significantly decreased through IVUS guidance compared to angiography guidance.
