Coronary IVUS

    IVUS guidance
    benefits patients

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    IVUS icon

    IVUS imaging helps you decide, guide and confirm the right interventional treatment for each patient. IVUS-guided strategies are backed by various studies and The Society for Cardiac Angiography and Interventions (SCAI) expert consensus statement states that IVUS is “definitely beneficial”.1 Explore the various studies below to learn more.

    ADAPT-DES

    PCI strategy changed 74% of the time2


    The ADAPT-DES study reported that IVUS guidance was associated with a change in PCI strategy 74% of the time.2 Most often, the impact was a larger size of stent or balloon followed by post-dilation. Furthermore, the study reported that larger stent areas resulted in cases where both pre-and post-PCI IVUS were performed compared to when only post-PCI IVUS was performed.
    PCI strategy graph

    34% reduction in MACE3

    The ADAPT-DES study reported that IVUS guidance was associated with a 34% reduction in major adverse cardiac events (MACE) at 2 years (4.9% vs 7.4%, p < 0.001).3
    Reduction in mace graph

    34%

    reduction in MACE associated with IVUS guidance
     

    Relationship between IVUS use and MACE (definite/probable ST, cardiac death, MI) within 2 years

    ULTIMATE all-comers RCT

    Intravascular ultrasound-guided versus angiography-guided implantation of drug-eluting stent in all-comers.4

    “Routine IVUS-guided DES implantation is associated with fewer major adverse cardiac events (MACE) compared with angiography guidance for patients with individual lesion subset. However, prior to the ULTIMATE trial the beneficiary effect on MACE outcome from IVUS-guidance over angiography-guidance in all-comers who undergo DES implantation remained understudied.”

    — Zhang J et al 4

    Primary endpoint based on patient-level comparison

    Primary endpoint on patient level comparison
    %86 graphic

    Increased rate of TVF* at one year without IVUS-guided PCI.

    *(TVF categorized as cardiac death, target vessel MI and clinically driven TVR)

    Target vessel failure increased by 175% when pre-specified IVUS criteria for optimal PCI was not achieved

    Primary endpoint for patients who meet/didn’t meet IVUS criteria

    Primary endpoint for patients on IVUS criteria

    Imaging standardization with 3 IVUS defined criteria to achieve optimal PCI

    3 IVUS defined criteria

    Plaque burden at the 5-mm proximal or distal to the stent edge <50%.

    Expansion satisfactory: Minimal lumen CSA in stented segment >5mm2, or 90% of distal reference lumen CSA

    No edge dissection involving media with length >3mm.

    Ahn meta-analysis

    Largest study of IVUS guidance data with 39 distinct studies enrolling more then 36,000 patients


    A large body of evidence from randomized trials, observational studies, and meta-analyses reports that IVUS guidance is associated with reduced MACE.5,6,7,8,9
    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
    DES patients
    26503
    3192
    18707
    19619
    24849
    36831

    Ahn meta-analysis

    Largest study of IVUS guidance data with 39 distinct studies enrolling more then 36,000 patients


    A large body of evidence from randomized trials, observational studies, and meta-analyses reports that IVUS guidance is associated with reduced MACE.5,6,7,8,9
    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
    ivus guidance table xs

    Samsung registry

    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.10

    Clinical outcomes

    Clinical outcomes
    Samsung registry table

    Economic impact of IVUS

    Economic impact of IVUS

    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.11


    • 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.

    Clinical evidence slide

    Clinical evidence slides for download
    If you would like to receive a deck of slides that you can use in presentations on the evidence and guidelines for the use of IVUS in PCI, please enter your name and email address below. These slides are provided on a blank background so you may adapt them to your own templates so long as all footnotes remain visible.

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    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. 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.

    3. Witzenbichler B. ADAPT-DES: Two-Year Insights from the Largest IVUS Substudy. TCT 2013: Transcatheter Cardiovascular Therapeutics 25th Annual Scientific Symposium. Lecture conducted from San Francisco, CA.

    4. Zhang J et al. The ULTIMATE trial. Journal of the American College of Cardiology (2018), doi.org/10.1016/j.jacc.2018.09.013

    5. 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.

    6. 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

    7. 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

    8. 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

    9. 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.

    10. 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.

    11. Alberti. Understanding the economic impact of intravascular ultrasound. Eur J Health Econ (2016) 17:185–193