Amgad Mentias1, Mary Vaughan Sarrazin2, Marwan Saad3, Sidakpal Panaich4, Samir Kapadia5, Phillip A Horwitz4, Saket Girotra4. 1. Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: dr.amgadgamal@gmail.com. 2. Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, Iowa. 3. Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 4. Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 5. Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Abstract
OBJECTIVES: This study sought to explore if intravascular ultrasound (IVUS) use in real-world patients is associated with improved long-term outcomes of percutaneous coronary intervention (PCI). BACKGROUND: The benefit of IVUS use with PCI in real world is uncertain. METHODS: We identified Medicare patients who underwent PCI from 2009 to 2017 and evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. We used propensity score matching and inverse probability weighting to adjust for baseline characteristics. To account for hospital effects, patients undergoing IVUS-guided PCI were matched to non-IVUS patients in the same hospital and year. Sensitivity analyses comparing outcomes with and without IVUS in stable coronary artery disease and acute coronary syndrome, PCI with bare-metal stents and drug-eluting stents, complex and noncomplex PCI, and facilities with 1% to 5%, 5% to 10%, and >10% IVUS use were performed. RESULTS: Overall, IVUS was used in 5.6% of all PCI patients (105,787 out of 1,877,177 patients). Patients with IVUS-guided PCI had a higher prevalence of most comorbidities. In the propensity matched analysis, IVUS-guided PCI was associated with lower 1-year mortality (11.5% vs. 12.3%), MI (4.9% vs. 5.2%), and repeat revascularization (6.1% vs. 6.7%) (p < 0.001 for all). In inverse probability weighting analysis with a median follow-up of 3.7 years (interquartile range: 1.7 to 6.4 years), IVUS-guided PCI was associated with a lower risk of mortality (adjusted hazard ratio [aHR]: 0.903; 95% confidence interval [CI]: 0.885 to 0.922), MI (aHR: 0.899; 95% CI: 0.893 to 0.904), and repeat revascularization (aHR: 0.893; 95% CI: 0.887 to 0.898) (p < 0.001 for all). These findings were consistent in all subgroups in sensitivity analyses. CONCLUSIONS: In this contemporary U.S. Medicare cohort, the use of IVUS guidance in PCI remains low. Use of IVUS is associated with lower long-term mortality, MI, and repeat revascularization.
OBJECTIVES: This study sought to explore if intravascular ultrasound (IVUS) use in real-world patients is associated with improved long-term outcomes of percutaneous coronary intervention (PCI). BACKGROUND: The benefit of IVUS use with PCI in real world is uncertain. METHODS: We identified Medicare patients who underwent PCI from 2009 to 2017 and evaluated the association of IVUS use with long-term risk of mortality, myocardial infarction (MI), and repeat revascularization. We used propensity score matching and inverse probability weighting to adjust for baseline characteristics. To account for hospital effects, patients undergoing IVUS-guided PCI were matched to non-IVUSpatients in the same hospital and year. Sensitivity analyses comparing outcomes with and without IVUS in stable coronary artery disease and acute coronary syndrome, PCI with bare-metal stents and drug-eluting stents, complex and noncomplex PCI, and facilities with 1% to 5%, 5% to 10%, and >10% IVUS use were performed. RESULTS: Overall, IVUS was used in 5.6% of all PCI patients (105,787 out of 1,877,177 patients). Patients with IVUS-guided PCI had a higher prevalence of most comorbidities. In the propensity matched analysis, IVUS-guided PCI was associated with lower 1-year mortality (11.5% vs. 12.3%), MI (4.9% vs. 5.2%), and repeat revascularization (6.1% vs. 6.7%) (p < 0.001 for all). In inverse probability weighting analysis with a median follow-up of 3.7 years (interquartile range: 1.7 to 6.4 years), IVUS-guided PCI was associated with a lower risk of mortality (adjusted hazard ratio [aHR]: 0.903; 95% confidence interval [CI]: 0.885 to 0.922), MI (aHR: 0.899; 95% CI: 0.893 to 0.904), and repeat revascularization (aHR: 0.893; 95% CI: 0.887 to 0.898) (p < 0.001 for all). These findings were consistent in all subgroups in sensitivity analyses. CONCLUSIONS: In this contemporary U.S. Medicare cohort, the use of IVUS guidance in PCI remains low. Use of IVUS is associated with lower long-term mortality, MI, and repeat revascularization.
Authors: Glenn N Levine; Eric R Bates; James C Blankenship; Steven R Bailey; John A Bittl; Bojan Cercek; Charles E Chambers; Stephen G Ellis; Robert A Guyton; Steven M Hollenberg; Umesh N Khot; Richard A Lange; Laura Mauri; Roxana Mehran; Issam D Moussa; Debabrata Mukherjee; Brahmajee K Nallamothu; Henry H Ting Journal: J Am Coll Cardiol Date: 2011-11-07 Impact factor: 24.094
Authors: Alaide Chieffo; Azeem Latib; Christophe Caussin; Patrizia Presbitero; Stefano Galli; Alberto Menozzi; Ferdinando Varbella; Fina Mauri; Marco Valgimigli; Chourmouzios Arampatzis; Manuel Sabate; Andrejs Erglis; Bernhard Reimers; Flavio Airoldi; Mika Laine; Ramon Lopez Palop; Ghada Mikhail; Philip Maccarthy; Francesco Romeo; Antonio Colombo Journal: Am Heart J Date: 2012-11-20 Impact factor: 4.749
Authors: Bernhard Witzenbichler; Akiko Maehara; Giora Weisz; Franz-Josef Neumann; Michael J Rinaldi; D Christopher Metzger; Timothy D Henry; David A Cox; Peter L Duffy; Bruce R Brodie; Thomas D Stuckey; Ernest L Mazzaferri; Ke Xu; Helen Parise; Roxana Mehran; Gary S Mintz; Gregg W Stone Journal: Circulation Date: 2013-11-26 Impact factor: 29.690
Authors: Alka B Patel; Hude Quan; Robert C Welsh; Jessica Deckert-Sookram; Wayne Tymchak; Sunil Sookram; Ian Surdhar; Padma Kaul Journal: CMAJ Open Date: 2015-10-02
Authors: Judit Karacsonyi; Khaldoon Alaswad; Farouc A Jaffer; Robert W Yeh; Mitul Patel; John Bahadorani; Aris Karatasakis; Barbara A Danek; Anthony Doing; J Aaron Grantham; Dimitri Karmpaliotis; Jeffrey W Moses; Ajay Kirtane; Manish Parikh; Ziad Ali; William L Lombardi; David E Kandzari; Nicholas Lembo; Santiago Garcia; Michael R Wyman; Aya Alame; Phuong-Khanh J Nguyen-Trong; Erica Resendes; Pratik Kalsaria; Bavana V Rangan; Imre Ungi; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis Journal: J Am Heart Assoc Date: 2016-08-20 Impact factor: 5.501
Authors: Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Lorenzo Azzalini; Brian A Bergmark; Yiannis S Chatzizisis; Allison B Hall; Jason Wollmuth; Kevin Croce; Hani Jneid; Bavana V Rangan; M Nicholas Burke; Emmanouil S Brilakis Journal: J Invasive Cardiol Date: 2022-01 Impact factor: 2.022
Authors: Piotr Rola; Jan Jakub Kulczycki; Adrian Włodarczak; Mateusz Barycki; Szymon Włodarczak; Marek Szudrowicz; Łukasz Furtan; Artur Jastrzębski; Maciej Pęcherzewski; Maciej Lesiak; Adrian Doroszko Journal: Int J Environ Res Public Health Date: 2022-07-25 Impact factor: 4.614