Author + information
- Received December 17, 2013
- Revision received April 25, 2014
- Accepted May 22, 2014
- Published online November 1, 2014.
- José Mariani Jr., MD∗,
- Cristiano Guedes, MD∗,
- Paulo Soares, MD, PhD∗,
- Silvio Zalc, MD, PhD∗,
- Carlos M. Campos, MD∗,†,
- Augusto C. Lopes, MD‡,
- André G. Spadaro, MD∗,
- Marco A. Perin, MD, PhD∗,
- Antonio Esteves Filho, MD∗,
- Celso K. Takimura, MD, PhD∗,
- Expedito Ribeiro, MD, PhD∗,
- Roberto Kalil-Filho, MD, PhD∗,
- Elazer R. Edelman, MD, PhD‡,§,
- Patrick W. Serruys, MD, PhD†,‖ and
- Pedro A. Lemos, MD, PhD∗∗ ()
- ∗Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- †Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- ‡Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- §Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- ‖Imperial College London, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Pedro A. Lemos, Heart Institute (InCor), Service of Interventional Cardiology, Av. Dr. Eneas Carvalho de Aguiar, 44, Bloco I, 3° andar, Hemodinâmica, São Paulo-SP 05403-000, Brazil.
Objectives The aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI).
Background To date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast.
Methods A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months.
Results The median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p < 0.001). Similarly, the median volume of contrast/creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI (1.0 [IQR: 0.6 to 1.9] vs. 0.4 [IQR: 0.2 to 0.6, respectively; p < 0.001). In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI.
Conclusions Thoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance. The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty. (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy [MOZART]; NCT01947335)
The present study is an investigator-sponsored study partially supported by Boston Scientific Corporation. Dr. Lemos is supported in part by a grant from the National Council for Scientific and Technological Development (CNPq)—Brazil. Dr. Edelman is supported in part by a grant from the U.S. National Institutes of Health (R01 GM49039). Dr. Lopes is supported by an Arie Fellowship from the Brazilian Society of Interventional Cardiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 17, 2013.
- Revision received April 25, 2014.
- Accepted May 22, 2014.
- American College of Cardiology Foundation