Imaging standardization with 3 IVUS defined
criteria to achieve optimal PCI
The IVUS-XPL study was a prospective, multi-center, randomized trial resulting in:
Source | The American Journal of Cardiology | Circulations Cardiovascular Interventions | International Journal of Cardiology | EuroIntervention | JACC Cardiovascular Interventions | Total |
Author | Ahn JM | Elgendy IY | Klersey C | Zhang YJ | Jang JS | |
IVUS patients | 12499 | 1593 | 9965 | 8102 | 11793 | 15469* |
Total DES patients | 26503 | 3192 | 18707 | 19619 | 24849 | 36831* |
Source | Author | IVUS patients | DES patients |
The American Journal of Cardiology | Ahn JM | 12499 | 26503 |
Circulations Cardiovascular Interventions | Elgendy IY | 1593 | 3192 |
International Journal of Cardiology | Klersey C | 9965 | 18707 |
EuroIntervention | Zhang YJ | 8102 | 19619 |
JACC Cardiovascular Interventions | Jang JS | 11793 | 24849 |
Total | | 15469 | 36831 |
6,005 patients who had at least one complex lesion undergoing PCI with drug-eluting stents were enrolled in a prospective institutional registry. IVUS guidance was used on 1,674 enrolled patients. IVUS-guided PCI was associated with 43% lower risk of cardiac death during 64 months of median follow-up compared with angiography-guided PCI.12
An analysis of IVUS-guided PCI and angiography-guided PCI from an Italian healthcare payer perspective found that IVUS-guided PCI with DES is a dominant treatment option compared to angiography-guided PCI with DES.13
• The analysis modeled incremental cost effectiveness based on DRG tariffs and outcomes data from the Ahn meta-analysis.
• Most data points are in the south-east quadrant indicating better outcomes and lower costs with IVUS-guidance versus angiography alone.
• Cost savings increased in patients with diabetes, renal insufficiency, or ACS and were associated with less MI and revascularization.
1. Klersey C, et al. Use of IVUS guided coronary stenting with drug eluting stent: A systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int J Cardiol. 2013 Dec 5;170(1):54-63.
2. Hong S-J, et al. “Effect of Intravascular Ultrasound-guided Drug-Eluting Stent Implantation: Five-Year Follow-Up of the IVUS-XPL Randomized Trial, JACC: Cardiovascular Interventions (2019), doi: https://doi.org/10.1016/j.jcin.2019.09.033
3. Witzenbichler B, Maehara A, Weisz G, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation. 2014;129(4):463-470.
4. A. Maehara, ADAPT-DES IVUS Substudy: Utility of IVUS in delineating the Mechanism of and Preventing Stent Thrombosis, TCT Presentation October 24, 2012
5. Maehara A. Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents. Circ Cardiovasc Interv. 2018 Nov;11(11):e006243
6. Zhang J et al. The ULTIMATE trial. Journal of the American College of Cardiology (2018), doi.org/10.1016/j.jacc.2018.09.013
7. Ahn JM, Kang SJ, Yoon SH, et al. Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. Am J Cardiol. 2014;113:1338-1347.
8. Elgendy IY et al. Outomes with Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents. Circ Cardiovasc Interv. 2016;9:e003700
9. Jang JS, et al. Intravascular Ultrasound-Guided Implantation of Drug-Eluting Stents to Improve Outcome, A Meta-Analysis. J Am Coll Cardiol Intv. 2014;7(3):233-243
10. Zhang YJ, et al. Comparison of intravascular ultrasound versus angiography-guided drug-eluting stent implantation: a meta-analysis of one randomized trial and ten observational studies involving 19,619 patients. EuroIntervention. 2013;9:891-892
11. Klersey C, et al. Use of IVUS guided coronary stenting with drug eluting stent: A systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int J Cardiol. 2013 Dec 5;170(1):54-63.
12. Choi KH, Song YB, Lee JM, et al. Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures. JACC Cardiovasc Interv. 2019;12:607–20.
13. Alberti. Understanding the economic impact of intravascular ultrasound. Eur J Health Econ (2016) 17:185–193
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