Understanding the economic impact of intravascular ultrasound (IVUS)

Alberti, Alessandro; Giudice, Pietro; Gelera, A.; Stefanini, Luca; Priest, Virginia; Simmonds, Michael J.; Lee, Christa; Wasserman, Matt

doi:10.1007/s10198-015-0670-4

Cited by 69 publications

(31 citation statements)

References 25 publications

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“…36 However, a previous study had suggested that IVUS guidance was not only cost-effective, but may be cost-saving among patients who are at increased risk of restenosis (eg, diabetics, chronic kidney disease, and acute coronary syndromes). 37 The results of this analysis support the recommendation to expand the routine use of IVUS for revascularization of diffuse lesions (ie, >30 mm).…”

Section: Elgendy Et Al Ivus-versus Angiography-guided Des Implantationsupporting

confidence: 60%

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Elgendy

Mahmoud

Bavry

2016

Circ: Cardiovascular Interventions

176

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I ntravascular ultrasound (IVUS) is a useful tool for optimization of stent implantation by insuring good stent expansion and apposition. [1][2][3][4][5] Despite this benefit, routine IVUS is limited by cost considerations and additional time that is needed to perform the procedure. It is also unknown which coronary lesion characteristics are best served by IVUS. A meta-analysis of randomized trials in the era of bare-metal stents concluded that IVUS guidance was associated with a reduction in major adverse cardiac events (MACE) and repeat revascularization with a neutral effect on death and myocardial infarction (MI).6 Percutaneous coronary intervention (PCI) is currently performed with drug-eluting stents, which has significantly reduced the risk for restenosis, compared with bare-metal stents.7 A large-scale network meta-analysis demonstrated that all drug-eluting stents (and in particular second generation drug-eluting stents) reduce adverse events compared with bare-metal stents.8 Accordingly, in present day practice, there may be less need for a routine IVUS-guided PCI approach. Meta-analyses in the era of drug-eluting stents were influenced by including observational studies. [9][10][11][12][13] Furthermore, the results of additional multicenter randomized trials have become available.14-16 Therefore, we aimed to conduct an updated comprehensive meta-analysis of randomized trials to evaluate clinical outcomes associated with IVUSguided PCI compared with angiography-guided PCI in the era of drug-eluting stents.Background-In the era of drug-eluting stents, it is unknown if intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention should be routinely endorsed. This study aimed to determine if IVUS-guided stent implantation is associated with improved outcomes. Methods and Results-Randomized trials that reported clinical outcomes and compared routine IVUS-guided stent implantation with an angiography-guided approach in the era of drug-eluting stents were included. Summary estimates were constructed primarily using the Peto model. Seven trials with 3192 patients were analyzed. The mean length of the coronary lesions was 32 mm. At a mean of 15 months, routine IVUS-guided percutaneous coronary intervention was associated with a reduction in the risk of major adverse cardiac events (6.5% versus 10.3%; odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly because of reduction in the risk of ischemia-driven target lesion revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5% versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00; P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95% confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the IVUS-guided group. Conclusions-In the era of drug-eluting stents for diffuse coronary lesions, IVUS-guided percutaneous coronary intervention is superior to angiography-guided percutaneous coronary intervention...

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Section: Elgendy Et Al Ivus-versus Angiography-guided Des Implantationsupporting

confidence: 60%

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Elgendy

Mahmoud

Bavry

2016

Circ: Cardiovascular Interventions

176

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“…Although the economic benefits of IVUS decrease after the first year, the benefits persist during a longer follow-up (11). Alberti et al (25) suggested that IVUS guidance was not only cost-effective, but may be cost-saving among patients who are at an increased risk of restenosis. This investigation demonstrated that patients in the IVUS-guided group had an increased number of implanted stents, a greater diameter, and length of stents and that the percentage of high-pressure balloons used post-dilatation decreased the incidence of stent restenosis when compared with the CAG-guided group.…”

Section: Discussionmentioning

confidence: 99%

The clinical utility of intravascular ultrasonography (IVUS)-guided therapy for small-vessel coronary lesion associated with type-2 diabetes mellitus

Wang

Zhai

et al. 2019

Anatol J Cardiol

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Objective:It is unknown whether the intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) should be routinely used in small-vessel coronary lesions in patients affected by Type 2 diabetes mellitus (T2DM). This study aimed to assess the clinical significance of the IVUS-guided PCI treatment for small-vessel coronary lesions in T2DM.Methods:This was a prospective interventional trial. A total of 228 patients affected by T2DM with stable angina and a positive stress test in the presence of coronary arteriography (CAG) involving small vessels [online measurement reference vessel diameter ≤3.0 mm by means of quantitative coronary angiography (QCA)] were recruited and divided into two groups: an IVUS-guided group (n=120) and a CAG-guided group (n=108). Follow-up PCIs were performed via CAG or IVUS criteria, respectively. Between-group comparisons were made for the number of stents implanted, length, diameter, and high-pressure balloons used post-dilatation. Major adverse cardiac events (MACEs) defined as cardiac death, nonfatal myocardial infarction, and target lesion revascularization (TLR) were the primary endpoint. The value of late lumen loss and proportion of in-stent restenosis (ISR) were the secondary endpoint, all of which were also evaluated during the follow-up period.Results:There was an increased lesion length observed using the IVUS measurement when compared with QCA measurements in the IVUS-guided group (p≤0.001). The number of implanted stents, diameter, length, percentage of high-pressure balloons used during post-dilatation, value of late lumen loss, and proportion of ISR decreased in the IVUS-guided group when compared with the CAG-guided group (p=0.002, p=0.001, p=0.003, p=0.004, p=0.007, p=0.001, respectively). After a 2-year follow-up, the Kaplan–Meier curves indicated that the incidence of MACEs was significantly lower in the IVUS-guided group (log-rank p=0.029), mainly because of the TLR reduction (log-rank p=0.037).Conclusion:The IVUS-guided PCI treatment improved the event-free survival in small-vessel coronary lesions in patients affected by T2DM.

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“…However, one should also consider that: (1) the clinical use of IVUS was reportedly low, even in higher-income countries without restrictive limitations in reimbursement (e.g., IVI was used frequently by 9.1% of respondents in Switzerland vs. 10.4% of respondents from Europe overall); and (2) IVUS-guided PCI appears to be a cost-effective approach according to a dedicated economic analysis. 12 Therefore, claims of high cost may not fully explain the relatively limited use of IVI in countries outside Japan. Clinical use of these invasive modalities…”

Section: Discussionmentioning

confidence: 99%

Current use of intracoronary imaging in interventional practice – Results of a European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Japanese Association of Cardiovascular Interventions and Therapeutics (CVIT) Clinical Practice Survey

Koskinas¹,

Nakamura²,

Räber³

et al. 2018

EuroIntervention

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In a sample of predominantly experienced interventional cardiologists, there was a high rate of personal experience with IVI in clinical practice. The most commonly identified indications for IVI were optimization of stenting, procedural/strategy guidance, and guidance of left main interventions. Variability in practice patterns is substantial according to geographic region and interventional experience.

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Understanding the economic impact of intravascular ultrasound (IVUS)

Cited by 69 publications

References 25 publications

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

The clinical utility of intravascular ultrasonography (IVUS)-guided therapy for small-vessel coronary lesion associated with type-2 diabetes mellitus

Current use of intracoronary imaging in interventional practice – Results of a European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Japanese Association of Cardiovascular Interventions and Therapeutics (CVIT) Clinical Practice Survey

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