Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

Ko Yamamoto; Hiroki Shiomi; Takeshi Morimoto; Hiroki Watanabe; Akiyoshi Miyazawa; Kyohei Yamaji; Masanobu Ohya; Sunao Nakamura; Satoru Mitomo; Satoru Suwa; Takenori Domei; Shojiro Tatsushima; Koh Ono; Hiroki Sakamoto; Kiyotaka Shimamura; Masataka Shigetoshi; Ryoji Taniguchi; Yuji Nishimoto; Hideki Okayama; Kensho Matsuda; Takafumi Yokomatsu; Masahiro Muto; Ren Kawaguchi; Koichi Kishi; Mitsuyoshi Hadase; Tsutomu Fujita; Yasunori Nishida; Masami Nishino; Hiromasa Otake; Kengo Tanabe; Mitsuru Abe; Kiyoshi Hibi; Kazushige Kadota; Kenji Ando; Takeshi Kimura; OPTIVUS-Complex PCI Investigators

doi:10.1016/j.jacasi.2022.12.009

Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

JACC Asia. 2023 Mar 11;3(2):211-225. doi: 10.1016/j.jacasi.2022.12.009. eCollection 2023 Apr.

Authors

Ko Yamamoto¹, Hiroki Shiomi¹, Takeshi Morimoto², Hiroki Watanabe³, Akiyoshi Miyazawa⁴, Kyohei Yamaji¹, Masanobu Ohya⁵, Sunao Nakamura⁶, Satoru Mitomo⁶, Satoru Suwa⁷, Takenori Domei⁸, Shojiro Tatsushima³, Koh Ono¹, Hiroki Sakamoto⁹, Kiyotaka Shimamura⁹, Masataka Shigetoshi¹⁰, Ryoji Taniguchi¹¹, Yuji Nishimoto¹¹, Hideki Okayama¹², Kensho Matsuda¹², Takafumi Yokomatsu¹³, Masahiro Muto¹⁴, Ren Kawaguchi¹⁵, Koichi Kishi¹⁶, Mitsuyoshi Hadase¹⁷, Tsutomu Fujita¹⁸, Yasunori Nishida¹⁹, Masami Nishino²⁰, Hiromasa Otake²¹, Kengo Tanabe²², Mitsuru Abe²³, Kiyoshi Hibi²⁴, Kazushige Kadota⁵, Kenji Ando⁸, Takeshi Kimura¹; OPTIVUS-Complex PCI Investigators

Affiliations

¹ Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
² Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
³ Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
⁴ Cardiocore Japan, Tokyo, Japan.
⁵ Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
⁶ Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan.
⁷ Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
⁸ Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
⁹ Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
¹⁰ Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
¹¹ Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
¹² Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
¹³ Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
¹⁴ Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan.
¹⁵ Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
¹⁶ Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan.
¹⁷ Department of Cardiology, Saiseikai Shiga Hospital, Ritto, Japan.
¹⁸ Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Sapporo, Japan.
¹⁹ Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan.
²⁰ Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
²¹ Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
²² Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
²³ Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
²⁴ Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.

Abstract

Background: Intravascular ultrasound (IVUS) was only rarely used in landmark trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel disease.

Objectives: The authors aimed to evaluate clinical outcomes after optimal IVUS-guided PCI in patients undergoing multivessel PCI.

Methods: The OPTIVUS (OPTimal IntraVascular UltraSound)-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified criteria (OPTIVUS criteria: minimum stent area > distal reference lumen area [stent length ≥28mm], and minimum stent area >0.8 × average reference lumen area [stent length <28mm]) for optimal stent expansion. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) (death/myocardial infarction/stroke/any coronary revascularization). The predefined performance goals were derived from the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome study in Kyoto) PCI/CABG registry cohort-2 fulfilling the inclusion criteria in this study.

Results: In this study, 40.1% of the patients met OPTIVUS criteria in all stented lesions. The cumulative 1-year incidence of the primary endpoint was 10.3% (95% CI: 8.4%-12.2%), which was significantly lower than the predefined PCI performance goal of 27.5% (P < 0.001), and which was numerically lower than the predefined CABG performance goal of 13.8%. The cumulative 1-year incidence of the primary endpoint was not significantly different regardless of meeting or not meeting OPTIVUS criteria.

Conclusions: Contemporary PCI practice conducted in the OPTIVUS-Complex PCI study multivessel cohort was associated with a significantly lower MACCE rate than the predefined PCI performance goal, and with a numerically lower MACCE rate than the predefined CABG performance goal at 1 year.

Keywords: coronary stent; intravascular ultrasound; percutaneous coronary intervention.