Clinical Impact of Intravascular Ultrasound-Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation: Randomized Study
- Abstract
- BACKGROUND: There have been no randomized studies comparing intravascular ultrasound (IVUS)-guided versus conventional angiography-guided chronic total occlusion (CTO) intervention using new-generation drug-eluting stent Therefore, we conducted a prospective, randomized, multicenter trial designed to test the hypothesis that IVUS-guided CTO intervention is superior to angiography-guided intervention. METHODS AND RESULTS: After successful guidewire crossing, 402 patients with CTOs were randomized to the IVUS-guided group (n=201) or the angiography-guided group (n=201) and secondarily randomized to Resolute zotarolimus-eluting stents or Nobori biolimus-eluting stents. The primary and secondary end points were cardiac death and a major adverse cardiac event defined as the composite of cardiac death, myocardial infarction, or target-vessel revascularization, respectively. After 12-month follow-up, the rate of cardiac death was not significantly different between the IVUS-guided group (0%) and the angiography-guided group (1.0%; P by log-rank test=0.16). However, major adverse cardiac event rates were significantly lower in the IVUS-guided group than that in the angiography-guided group (2.6% versus 7.1%; P=0.035; hazard ratio, 0.35; 95% confidence interval, 0.13-0.97). Occurrence of the composite of cardiac death or myocardial infarction was significantly lower in the IVUS-guided group (0%) than in the angiography-guided group (2.0%; P=0.045). The rates of target-vessel revascularization were not significantly different between the 2 groups. In the comparison between Resolute zotarolimus-eluting stent and Nobori biolimus-eluting stent, major adverse cardiac event rates were not significantly different (4.0% versus 5.7%; P=0.45). CONCLUSIONS: Although IVUS-guided CTO intervention did not significantly reduce cardiac mortality, this randomized study demonstrated that IVUS-guided CTO intervention might improve 12-month major adverse cardiac event rate after new-generation drug-eluting stent implantation when compared with conventional angiography-guided CTO intervention. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01563952.
- All Author(s)
- B. K. Kim
; D. H. Shin
; M. K. Hong
; H. S. Park
; S. W. Rha
; G. S. Mintz
; J. S. Kim
; S. J. Lee
; H. Y. Kim
; B. K. Hong
; W. C. Kang
; J. H. Choi
; Y. Jang
- Issued Date
- 2015
- Type
- Article
- Keyword
- coronary occlusion; drug-eluting stents; ultrasonography, interventional
- Publisher
- American Heart Association
- ISSN
- 1941-7640
- Citation Title
- Circulation: Cardiovascular Interventions
- Citation Volume
- 8
- Citation Number
- 7
- Citation Start Page
- e002592
- Citation End Page
- e002592
- Language(ISO)
- eng
- DOI
- 10.1161/CIRCINTERVENTIONS.115.002592
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/1753
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