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Clinical Impact of Intravascular Ultrasound-Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation: Randomized Study

Authors
 Byeong-Keuk Kim  ;  Dong-Ho Shin  ;  Myeong-Ki Hong  ;  Hun Sik Park  ;  Seung-Woon Rha  ;  Gary S. Mintz  ;  Jung-Sun Kim  ;  Je Sang Kim  ;  Seung-Jin Lee  ;  Hee-Yeol Kim  ;  Bum-Kee Hong  ;  Woong-Chol Kang  ;  Jin-Ho Choi  ;  Yangsoo Jang 
Citation
 Circulation. Cardiovascular Interventions, Vol.8(7) : 002592-002592, 2015 
Journal Title
 Circulation. Cardiovascular Interventions 
ISSN
 1941-7640 
Issue Date
2015
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.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141305
DOI
10.1161/CIRCINTERVENTIONS.115.002592
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김병극(Kim, Byeong Keuk) ; 김중선(Kim, Jung Sun) ; 신동호(Shin, Dong Ho) ; 장양수(Jang, Yang Soo) ; 홍명기(Hong, Myeong Ki) ; 홍범기(Hong, Bum Kee)
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Full Text
http://circinterventions.ahajournals.org/content/8/7/e002592.long
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