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IVUS Guidance for Extra Coronary Benefits

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What are the Benefits of IVUS?

ADAPT-DES Study Reported Improved Outcomes with IVUS Use1

The study goal was to evaluate outcomes in patients undergoing PCI with IVUS use versus no IVUS use. The ADAPT-DES study is the largest prospective, non-randomized, multicenter study to date with 8,582 patients enrolled with no exclusion criteria (IVUS arm = 3,361 patients, Angiographic arm = 5,221 patients).

2-Year Results Overview

IVUS guidance lead to the use of larger stents or balloons, more post-dilatation, additional stents, or higher pressures in 74% of patients – resulting in lower rates of ST, MI, and TLR.

  • IVUS use group reported a significant reduction in MI (38%), ST (53%), MACE (35%), and TLR (20%)
  • IVUS use was identified as an independent predictor of lower ST incidence

 

IVUS Use Changed the Procedure 74% of the Time
IVUS Use Group Reported 53% Reduction in Definite/Probable Stent Thrombosis

IVUS-XPL Randomized Clinical Trial2

The study goal was to determine whether the long-term clinical outcomes with IVUS-guided DES implantation are superior to those with angiography-guided implantation in patients with long coronary lesions (≥ 28 mm). The IVUS-XPL Study is the largest randomized, multi-center clinical trial for IVUS-guided vs. angio-guided stenting to date.

Results Overview:

  • IVUS group showed 48% lower MACE compared to angio-guided group (2.9% vs. 5.8%) at 1-year
  • Higher percentage of post dilatation in IVUS group (76% vs. 54%, P < 0.001)
  • Larger MLA post PCI in IVUS group

 

IVUS Use Group Showed 48% Lower MACE
Post-PCI QCA Data

IVUS Guidance in Left Main (LM) Lesions during PCI3 reported better outcomes in patients with LM disease undergoing revascularization with DES3

The study goal was to investigate the clinical impact of the use of IVUS during revascularization of patients with LM CAD using DES with drug-eluting stents (DES). The IVUS Guidance in Left Main Study pooled analysis of four registries involving 1,670 patients with LM disease. 505 patients who underwent IVUS-guided PCI compared to 505 propensity-matched patients where IVUS-guidance was not performed.

Results Overview:

  • MACE at 3-years was significantly lower in IVUS-guided group for both LM overall population (P = 0.04) and LM subgroups with distal lesions (P = 0.03)
  • IVUS use was an independent predictor for fewer adverse events
  • Further incremental benefit was shown in distal lesion subgroup receiving two stents
  • Definite and Probable ST was significantly lower in the IVUS-guided group (P = 0.04)

 

Significantly Lower MACE in IVUS-Guided Group
 
 
 

IVUS-Guided PCI Was More Cost Effective than Angio-Guided PCI in Studies

Cost Incurred to Treat a Patient
  • Results of a cost-effectiveness analysis in the United States demonstrated a reduction in MI, revascularization, and cardiac death among general CAD population treated with IVUS as compared to angiography alone.4 
  • IVUS was particularly effective in high risk subgroups, specifically in patients with diabetes, ACS, and Impaired Renal Function.5 
  • Evidence suggests that IVUS reduces the rate of severe cardiac events at 30 days, which may result in fewer MI related readmissions. Thirty-day readmissions are measured under the US CMS readmissions reduction program.6 
  • Over the lifetime of a CAD patient, IVUS could potentially save a total of $2,142 as compared to angiography alone.4 
  • The potential savings are even higher ($2,997, $2,879, and $3,257) when modeling patients with diabetes, ACS, and impaired renal function.4

Adverse cardiac events are a substantial burden to the health system:

  • Cost per MI: $8,039†
  • Cost per revascularization: $12,948**

 

 
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