Feature | September 26, 2014

IVUS-guided Interventions Show Improved Outcomes in Patients With CTOs

Results of IVUS-CTO Trial Reported at TCT 2014

IVUS, CTOs
September 14, 2014 – A new study found that intravascular ultrasound (IVUS)-guided intervention in patients with chronic total occlusion (CTO) could improve outcomes compared to a conventional angiography-guided approach during percutaneous coronary intervention (PCI). The IVUS-CTO study is the first randomized trial to examine the clinical impact of IVUS guidance for CTO intervention. Findings were reported at the Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. 
 
A chronic total occlusion is a complete or nearly complete blockage of a coronary artery that has been present for more than 30 days. PCI of CTO lesions is one of the most challenging forms of PCI, with some of the highest rates of recurrent restenosis due to the complexity of the procedures and lesions. IVUS evaluates coronary arteries using sound waves, and can be used to optimize post-PCI stent results, but whether there is demonstrable efficacy of this technique has not been adequately studied in CTO PCI.  
 
The prospective, multi-center trial randomized 402 patients with CTOs to either the IVUS-guided or angiography-guided groups after successful guidewire crossing. Patients were then additionally randomized to zotarolimus-eluting stents or biolimus-eluting stents. The primary endpoint was the composite of cardiac death, myocardial infarction, and target-vessel revascularization (TVR) at 12 months. Secondary endpoints included a composite rate of cardiac death or myocardial infarction and individual components of the primary endpoint.
 
After a 12-month follow up, occurrence of the primary endpoint was significantly lower in the IVUS-guided group compared to the angiography-guided group (2.6 vs. 7.1 percent; hazard ratio=0.35, 95% CI=0.13-0.97; p=0.035). Occurrence of the composite of cardiac death and myocardial infarction was also significantly lower in the IVUS-guided group vs. the angiography-guided group (p=0.045). IVUS guidance led to more aggressive balloon inflations during PCI. At follow-up, TVR was non-significantly lower in the IVUS-guided group compared with the angiography-guided group (2.6 vs. 5.2 percent; hazard ratio=0.48, 95% CI=0.17-1.42; p=0.186). 
 
Cross-over rates were 2.5 percent from IVUS-guided to the angiography-guided group, and 17.4 percent from angiography-guided to the IVUS-guided group (p<0.001). Based on the per-protocol analysis, occurrence of the primary endpoint was lower in the IVUS-guided group than in the angiography-guided group (2.2 vs. 8.4 percent; hazard ratio=0.26, 95% CI=0.09–0.71; p=0.005). 
 
“This first-of-its kind trial demonstrates that compared with conventional angiography-guided CTO intervention, IVUS-guided intervention significantly improved 12-month clinical outcomes after new-generation drug-eluting stent implantation,” said lead investigator Yang-Soo Jang, M.D., Ph.D. director of the Research Institute at the Severance Cardiovascular Hospital and Research Institute and Yonsei University Health System in Seoul, Korea. “Findings show that IVUS-guidance for CTO intervention is superior to the conventional approach.”
 
The IVUS-CTO trial was funded by a grant from the Cardiovascular Research Center in Seoul, Korea. Jang reported no disclosures.
 
For more information: www.crf.org, www.tctconference.com
 

Related Content

Hershey's Chocolate display with samples and coco pods at the American College of Cardiology (ACC) 2012 annual meeting. The company was making the case that chocolate can be good for your heart, which is now supported by several studies. Photo by Dave Fornell

Hershey's Chocolate display with samples and coco pods at the American College of Cardiology (ACC) 2012 annual meeting. The company was making the case that chocolate can be good for your heart, which is now supported by several studies. Photo by Dave Fornell

News | Cardiovascular Clinical Studies | July 22, 2020
July 22, 2020 — Eating chocolate at least once a week is linked with a reduced risk of heart disease, according to re
The first 3-D images have been created of an RNA molecule known as "Braveheart" for its role in transforming stem cells into heart cells. Credit: Image courtesy Los Alamos National Laboratory

The first 3-D images have been created of an RNA molecule known as "Braveheart" for its role in transforming stem cells into heart cells. Credit: Image courtesy Los Alamos National Laboratory

News | Cardiovascular Clinical Studies | January 20, 2020
January 20, 2020 — Scientists at Los Alamos and international partners have created the first 3-D images of a special
Top Cardiology New in 2019 From the European Society of Cardioloigy (ESC)
News | Cardiovascular Clinical Studies | December 23, 2019
Environmental and lifestyle issues were popular this year, with pick up from both...
News | Cardiovascular Clinical Studies | November 26, 2019
November 26, 2019 — The University of Connecticut (UConn) Department of Kinesiology and Hartford Healthcare have sele
FDA Issues Final Guidance on Live Case Presentations During IDE Clinical Trials
News | Cardiovascular Clinical Studies | July 10, 2019
The U.S. Food and Drug Administration (FDA) issued the final guidance “Live Case Presentations During Investigational...
Veradigm Partners With American College of Cardiology on Next-generation Research Registries
News | Cardiovascular Clinical Studies | July 03, 2019
The American College of Cardiology (ACC) has partnered with Veradigm, an Allscripts business unit, to power the next...
New FDA Proposed Rule Alters Informed Consent for Clinical Studies
News | Cardiovascular Clinical Studies | November 19, 2018
The U.S. Food and Drug Administration (FDA) is proposing to add an exception to informed consent requirements for...
A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp