TY - JOUR
T1 - Real-world use of intravascular ultrasound in Japan
T2 - a report from contemporary multicenter PCI registry
AU - Kuno, Toshiki
AU - Numasawa, Yohei
AU - Sawano, Mitsuaki
AU - Abe, Takayuki
AU - Ueda, Ikuko
AU - Kodaira, Masaki
AU - Suzuki, Masahiro
AU - Noma, Shigetaka
AU - Nakamura, Iwao
AU - Negishi, Koji
AU - Ishikawa, Shiro
AU - Fukuda, Keiichi
AU - Kohsaka, Shun
N1 - Funding Information:
The use of IVUS guidance in this registry was much higher compared to previous studies, including the registry data from Korea (43–55%) [ 9 , 25 , 26 ] the United States (US)/the Netherlands (42%) [ 27 ], the US alone (42.2%) [ 14 ], and Italy (5.2%) [ 28 ]. Japanese PCI operators tend to use IVUS more often and this has been a trend for more than a decade [ 12 ]. This is supported by recent meta-analyses that showed reduced incidence of death, MI, stent thrombosis [ 5 , 8 ]. And target lesion revascularization [ 8 ] among IVUS users compared to non-users. Higher rates of IVUS use in Japan might be a reason for reduced rates of mortality and stent thrombosis compared to European countries [ 12 ]. More optimal stent deployment, with a larger acute lumen gain, adequate stent apposition, and full lesion coverage with IVUS-guidance could all contribute to the improved outcomes. In accordance with this evidence, IVUS use could be supported since extensive use of IVUS was investigated, revealing lower complication rates. PCI registry data are heterogeneous populations in real-world practice. Demonstrating the safety of IVUS with all-comers registry data might promote IVUS use globally to improve PCI patients’ outcomes.
Funding Information:
The authors thank all the investigators, clinical coordinators, and institutions involved in the JCD-KiCS. Investigators: Toshiki Kuno, Yohei Numasawa, Masaki Kodaira, Ryota Tabei (Japanese Red Cross Ashikaga Hospital), Yutaka Okada (Eiju General Hospital), Soushin Inoue, Iwao Nakamura (Hino Municipal Hospital), Takaharu Katayama, Shunsuke Takagi, Takashi Matsubara (Hiratsuka City Hospital), Masashi Takahashi, Keishu Li, Koichiro Sueyoshi (Kawasaki City Municipal Hospital), Taku Inohara, Fumiaki Yashima, Atsushi Anzai, Kentaro Hayashida, Takashi Kawakami, Hideaki Kanazawa, Shunsuke Yuasa, Yuichiro Maekawa (Keio University School of Medicine), Masahiro Suzuki, Keisuke Matsumura (National Hospital Organization Saitama National Hospital) Yukinori Ikegami, Jun Fuse, Munehisa Sakamoto, Yukihiko Momiyama (National Hospital Organization Tokyo Medical Center), Ayaka Endo, Tasuku Hasegawa, Toshiyuki Takahashi, Susumu Nakagawa (Saiseikai Central Hospital), Takashi Yagi, Koji Ueno, Kenichiro Shimoji, Shigetaka Noma (Saiseikai Utsunomiya Hospital), Masahito Munakata, Takashi Akima, Shiro Ishikawa, Takashi Koyama (Saitama City Hospital), Atsushi Mizuno, Yutaro Nishi (St Luke?s International Hospital Heart Center), Toshimi Kageyama, Kazunori Moritani, Masaru Shibata (Tachikawa Kyosai Hospital), Kimi Koide, Yoshinori Mano, Takahiro Oki (Tokyo Dental College Ichikawa General Hospital), Daisuke Shinmura, Koji Negishi, Yusuke Jo, and Takahiro Koura (Yokohama Municipal Hospital). Clinical Coordinators: Junko Susa, Ayano Amagawa, Hiroaki Nagayama, Miho Umemura, Itsuka Saito, and Ikuko Ueda.
Publisher Copyright:
© 2019, Springer Japan KK, part of Springer Nature.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Clinical trial data suggest that intravascular ultrasound (IVUS) may improve clinical outcomes after PCI. The aim of this study was to investigate the safety of IVUS in its broader use for percutaneous coronary intervention (PCI). A total of 11,570 consecutive patients undergoing PCI between 2008 and 2014 in Japan were analyzed. Associations between IVUS use, PCI-related complications were assessed with logistic regression and propensity score matching analyses. Subgroup analysis was performed in elective PCI patients. IVUS was used in 84.8% of patients (N = 9814; IVUS group); its use was almost universal in elective PCIs (90.8 vs. 81.7% in urgent/emergent PCIs, P < 0.001). The non-IVUS group were older (68.7 ± 11.4 vs. 67.9 ± 10.8 years, P = 0.004), with more comorbid conditions. The non-IVUS group had smaller stent lumens (2.97 ± 0.42 mm vs. 3.09 ± 0.45 mm, P < 0.001) and a higher proportion of plain old balloon angioplasty. After matching, a lower rate of flow-impairing coronary dissections was observed in the IVUS group, although this was limited only to elective PCIs, not among urgent/emergent PCIs (non-IVUS vs. IVUS; 2.7% vs. 1.0%, P = 0.018, 0.7% vs. 1.2%, P = 0.32, respectively). With a multivariate logistic regression analysis, IVUS use remained an independent predictor to reduce risk of flow impairing severe coronary dissection among elective PCIs (odds ratio 0.38, 95% confidence interval 0.22–0.66: P = 0.001). In this Japanese PCI registry, IVUS was used extensively during the study period, particularly in elective cases. Using IVUS was associated with a lower event rate of flow-impairing coronary dissections that was limited to elective PCIs, not among urgent/emergent PCIs, without increasing PCI-related complications.
AB - Clinical trial data suggest that intravascular ultrasound (IVUS) may improve clinical outcomes after PCI. The aim of this study was to investigate the safety of IVUS in its broader use for percutaneous coronary intervention (PCI). A total of 11,570 consecutive patients undergoing PCI between 2008 and 2014 in Japan were analyzed. Associations between IVUS use, PCI-related complications were assessed with logistic regression and propensity score matching analyses. Subgroup analysis was performed in elective PCI patients. IVUS was used in 84.8% of patients (N = 9814; IVUS group); its use was almost universal in elective PCIs (90.8 vs. 81.7% in urgent/emergent PCIs, P < 0.001). The non-IVUS group were older (68.7 ± 11.4 vs. 67.9 ± 10.8 years, P = 0.004), with more comorbid conditions. The non-IVUS group had smaller stent lumens (2.97 ± 0.42 mm vs. 3.09 ± 0.45 mm, P < 0.001) and a higher proportion of plain old balloon angioplasty. After matching, a lower rate of flow-impairing coronary dissections was observed in the IVUS group, although this was limited only to elective PCIs, not among urgent/emergent PCIs (non-IVUS vs. IVUS; 2.7% vs. 1.0%, P = 0.018, 0.7% vs. 1.2%, P = 0.32, respectively). With a multivariate logistic regression analysis, IVUS use remained an independent predictor to reduce risk of flow impairing severe coronary dissection among elective PCIs (odds ratio 0.38, 95% confidence interval 0.22–0.66: P = 0.001). In this Japanese PCI registry, IVUS was used extensively during the study period, particularly in elective cases. Using IVUS was associated with a lower event rate of flow-impairing coronary dissections that was limited to elective PCIs, not among urgent/emergent PCIs, without increasing PCI-related complications.
KW - Coronary dissection
KW - Fluoroscopy time
KW - Intravascular ultrasound
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85071340700&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071340700&partnerID=8YFLogxK
U2 - 10.1007/s00380-019-01427-9
DO - 10.1007/s00380-019-01427-9
M3 - Article
C2 - 31129872
AN - SCOPUS:85071340700
SN - 0910-8327
VL - 34
SP - 1728
EP - 1739
JO - Heart and vessels
JF - Heart and vessels
IS - 11
ER -