Study on effects of package providing the free usage of intravascular ultrasound guided percutaneous coronary intervention with the implantation of two or more drug eluting stents in a high volume angioplasty centre in Singapore
Presenter
Fernando Loo, MBChB, Tan Tock Seng Hospital, Novena, Singapore
Fernando Loo, MBChB1, Cliff Li, MBBS1, Paul Ong2, Deanna Khoo2, Fahim Haider Jafary, M.D., FSCAI2 and Hee Hwa Ho3, (1)Tan Tock Seng Hospital, Novena, Singapore, (2)Tan Tock Seng Hospital, Singapore, Singapore, (3)Weill Cornell Medical Center, Singapore, NY
Keywords: Complications, Coronary, Diversity Equity and Inclusion (DEI), Drug-eluting Stent (DES) and Imaging & Physiology
Background
Intravascular ultrasound is under-utilised despite the evidence of improving coronary angioplasty outcomes. We investigate the effects of a bundled intravascular ultrasound (IVUS) plus everolimus-eluting stent (EES) package on utilisation rates and stent outcomes during percutaneous coronary intervention (PCI).
Methods
We retrospectively studied the number of stents, stent diameters, largest non-compliant balloon diameters, and total length of the stents implanted in patients before and after the introduction of the IVUS plus EES package.
Results
232 patients were included. Patients undergoing IVUS-guided PCI increased from 21.87% (21 out of 96 patients) to 45.58% (62 out of 136 patients) after package introduction. There were significantly more stents (1.45 +/- 0.58 vs 1.76 +/- 0.58, p=0.001) and longer length of stents (45.46 +/- 22.57mm vs 57.60 +/- 27.00mm, p=0.00039) after package introduction. There were no significant difference in the stent diameters (3.23 +/- 0.51mm vs 3.17 +/- 0.49mm, p=0.35) and NC balloon diameters (3.77 +/- 0.61mm vs 3.72 +/- 0.68mm, p=0.53). A separate analysis of PCI with and without IVUS yielded the following findings. Significantly more stents (1.50 +/- 0.71 vs 1.88 +/- 0.83, p= 0.00036), longer lengths (47.13 +/- 23.27mm vs 62.34 +/- 27.60mm, p=0.000013), larger stent diameters (3.13 +/- 0.50mm vs 3.34 +/- 0.49mm, p=0.002), and larger NC diameters (3.68 +/- 0.66mm vs 3.87 +/- 0.58mm (p=0.027) were achieved during IVUS-guided PCI.
Conclusions
Bundling IVUS with EES doubles its usage and increases number of stents implanted. IVUS-guided PCI achieves larger stent sizes which may translate to better patient outcomes.