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CTO intervention with IVUS vs. angiography reduces 1-year MACE
During chronic total occlusion intervention, guidance with IVUS compared with angiography significantly reduced the rate of MACE at 1 year, although it failed to lower cardiac mortality, according to results of the CTO-IVUS study.
“The use of [IVUS] has been recommended for the improvement of clinical outcomes after coronary intervention,” the investigators wrote. “However, no randomized study has compared [IVUS]-guided [CTO] intervention with conventional angiography-guided intervention using new-generation drug-eluting stents.”
For the prospective, randomized, multicenter study, the researchers randomly assigned 402 patients with CTOs after successful guidewire crossing to IVUS-guided (n = 201) or angiography-guided (n = 201) intervention. They secondarily randomly assigned patients to zotarolimus-eluting stents (Resolute, Medtronic) or biolimus-eluting stents (Nobori, Terumo).
Cardiac death served as the primary outcome measure and MACE — a composite of cardiac death, MI or target vessel revascularization — served as the secondary outcome measure.
At 12 months, the cardiac death rate was similar between groups (IVUS, 0% vs. angiography, 1%; P = .16), whereas MACE was reduced in the IVUS-guided intervention arm (2.6% vs. 7.1%; P = .035).
Furthermore, the rate of cardiac death or MI was lower in the IVUS-guided group (0% vs. 2 %; P = .045), but there was no difference in the rate of TVR.
In the analysis of the two different stent types, MACE outcomes did not differ significantly between models (Resolute, 4% vs. Nobori, 5.7%). – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.