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. 2023 Nov 1:206:79-85.
doi: 10.1016/j.amjcard.2023.08.051. Epub 2023 Sep 6.

Trends and Inhospital Outcomes of Intravascular Imaging on Single-Vessel Coronary Chronic Total Occlusion Treated With Percutaneous Coronary Intervention

Dae Yong Park  1 , Jiun-Ruey Hu  2 , Chanavuth Kanitsoraphan  3 , Ahmed Al-Ogaili  4 , Mukunthan Murthi  1 , Ufuk Vardar  1 , Yousif Ahmad  2 , Michael G Nanna  2 , Aviral Vij  5
Affiliations

Trends and Inhospital Outcomes of Intravascular Imaging on Single-Vessel Coronary Chronic Total Occlusion Treated With Percutaneous Coronary Intervention

Dae Yong Park et al. Am J Cardiol. .

Abstract

Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), improves outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). We sought to quantify temporal trends in the uptake of IVI for CTO-PCI in the United States. We identified adults who underwent single-vessel PCI for CTO between 2008 and 2020. We quantified yearly trends in the number of IVUS-guided and OCT-guided single-vessel CTO-PCIs by Cochran-Armitage and linear regression tests. We also examined the rates of inhospital mortality and other prespecified inhospital outcomes in patients who underwent CTO-PCIs with and without IVI, using logistic regression. Our study included a total of 151,998 PCIs on single-vessel CTOs, with the absolute number of CTO-PCIs decreasing from 12,345 in 2008 to 8,525 in 2020 (p trend <0.001). IVUS use has increased dramatically from 6% in 2008 to 18% in 2020 for single-vessel CTO-PCIs (p trend <0.001). Rates of OCT use have increased as well, from 0% in 2008 to 7% in 2020 (p trend <0.001). There was no difference in inhospital mortality between patients who underwent CTO-PCI with and without IVI (p logistic = 0.60). In the largest national analysis of single-vessel CTO-PCI trends to date, we found that the use of IVUS has increased substantially accompanied by a similar but lesser increase in the use of OCT. There were no differences in rates of inhospital mortality between patients who underwent single-vessel CTO-PCIs with and without IVI.

Keywords: chronic total occlusion; intravascular imaging; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention.

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Conflict of interest statement

Declaration of Competing Interest Dr. Ahmad is a consultant for Shockwave Medical and Cardiovascular Systems, Inc.; and on the Medical Advisory Board for Boston Scientific. Dr. Nanna reports current research support from the American College of Cardiology Foundation (Washington, District of Columbia) supported by the George F. and Ann Harris Bellows Foundation (Houston, Texas), the Patient-centered Outcomes Research Institute (PCORI) (Washington, District of Columbia), the Yale Claude D. Pepper Older Americans Independence Center, P30AG021,342, (New Haven, Connecticut) and the National Institute on Aging/National Institutes of Health (Bethesda, Maryland) from R03AG074067 (GEMSSTAR award). The remaining authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Flow-chart of this study
The flow diagram illustrates the process whereby single-vessel percutaneous interventions performed for chronic total occlusion were identified.
Figure 2.
Figure 2.. Trend of intravascular imaging-guided single-vessel CTO-PCIs
The graphs show the trend of IVUS-guided (Figure 2A) and OCT-guided (Figure 2B) single-vessel CTO-PCIs from year 2008 to 2020. The blue graphs represent IVUS- or OCT-guided single-vessel CTO-PCIs per 1,000 single-vessel CTO-PCIs, while the red line represents the percentage of IVUS- or OCT-guided single-vessel CTO-PCIs. The dotted red line shows the line of best fit. Abbreviations: CTO, chronic total occlusion; IVUS, intravascular ultrasound; OCT, optical coherence tomography; PCI, percutaneous coronary intervention
Figure 3.
Figure 3.. Comparison of in-hospital mortality between intravascular imaging and non-intravascular imaging single-vessel CTO-PCIs in different subgroups
The figure shows the adjusted odds ratio of in-hospital mortality after intravascular imaging-guided versus conventional single-vessel CTO-PCIs in different subgroups. The vertical line represents the adjusted odds ratio while the horizontal line represents the 95% confidence interval. The sizes of the blue squares are inversely proportional to the width of the 95% confidence interval. Abbreviation: CABG, coronary artery bypass graft; CI, confidence interval; CKD, chronic kidney disease; CTO, chronic total occlusion; OR, odds ratio; PCI, percutaneous coronary intervention
See this image and copyright information in PMC

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