Comparison of the OPTIVUS-Complex PCI Multivessel Cohort With the Historical CREDO-Kyoto Registry Cohort-3

Abstract

Background: There is a paucity of data on the effect of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with standard PCI or coronary artery bypass grafting (CABG) in patients with multivessel disease. Methods and Results:The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI including the left anterior descending coronary artery using IVUS aiming to meet the prespecified criteria for optimal stent expansion. We conducted propensity score matching analyses between the OPTIVUS group and historical PCI or CABG control groups from the CREDO-Kyoto registry cohort-3 (1,565 and 899 patients) fulfilling the inclusion criteria for this study. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. In the propensity score-matched cohort (OPTIVUS vs. historical PCI control: 926 patients in each group; OPTIVUS vs. historical CABG control: 436 patients in each group), the cumulative 1-year incidence of the primary endpoint was significantly lower in the OPTIVUS group than in the historical PCI control group (10.4% vs. 23.3%; log-rank P<0.001) or the historical CABG control group (11.8% vs. 16.5%; log-rank P=0.02).Conclusions: IVUS-guided PCI targeting the OPTIVUS criteria combined with contemporary clinical practice was associated with superior clinical outcomes at 1 year compared with not only the historical PCI control, but also the historical CABG control.

Does Intravascular Imaging-guided Percutaneous Coronary Intervention Improve Clinical Outcomes?

“…23) . The OPTIVUS-Complex PCI study multivessel cohort also suggested that optimal IVUS-guided PCI was associated with superior clinical outcomes at one year compared with historical CABG controls in the CREDO-Kyoto registry cohort-3 24) .…”

CVIT 2023 clinical expert consensus document on intravascular ultrasound

“…Recently, the OPTIVUS-Complex PCI study, a prospective, multi-center registry in Japan demonstrated that IVUS-guided PCI aiming to meet the prespecified OPTI-VUS criteria for optimal stent expansion (minimum stent area > distal reference lumen area [stent length ≥ 28 mm], and minimum stent area > 0.8 × average reference lumen area [stent length < 28 mm]) in patients with multi-vessel disease resulted in low target lesion revascularization rates of around 2% at 1 year at patient and lesion levels [56][57][58].…”

Dual Antiplatelet Therapy Duration After Multivessel Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention

“…The cumulative incidence of DAPT discontinuation was only 22.6% at 90 days and 68.8% at 1 year, although these were much higher than in the CREDO-Kyoto registry cohort-3, which was a real-world observational study conducted between 2011 and 2013 (3.3% at 90 days, and 18.9% at 1 year). 8 The enrollment into the present study started in March 2019, when the STOPDAPT-2 trial results were released suggesting the safety and efficacy of 1-month DAPT followed by clopidogrel monotherapy after PCI using drug-eluting stents. 2 The Japanese guideline on antithrombotic therapy after PCI was revised in March 2020 to recommend 1-3 months of DAPT after PCI in patients with HBR or low thrombotic risk.…”

“…The design, patient enrollment, and main results at 1 year were previously reported in detail. 7, 8 Written informed consent was provided from real-world DAPT strategies and the effect of shorter DAPT relative to longer DAPT after multivessel PCI. The OPTIVUS-Complex PCI (Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention) multivessel cohort was a prospective multicenter single-arm study enrolling patients who underwent IVUS-guided multivessel PCI with a target of prespecified criteria for optimal stent implantation.…”