Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial
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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | en_US |
| Published: |
Elsevier
2016
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| Online Access: | http://hdl.handle.net/1721.1/102986 https://orcid.org/0000-0002-7832-7156 |
| _version_ | 1826203572731117568 |
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| author | Mariani, José Guedes, Cristiano Soares, Paulo Zalc, Silvio Campos, Carlos M. Lopes, Augusto Celso de Araujo Spadaro, André G. Perin, Marco A. Filho, Antonio Esteves Takimura, Celso K. Ribeiro, Expedito Kalil-Filho, Roberto Edelman, Elazer R. Serruys, Patrick W. Lemos, Pedro A. |
| author2 | Institute for Medical Engineering and Science |
| author_facet | Institute for Medical Engineering and Science Mariani, José Guedes, Cristiano Soares, Paulo Zalc, Silvio Campos, Carlos M. Lopes, Augusto Celso de Araujo Spadaro, André G. Perin, Marco A. Filho, Antonio Esteves Takimura, Celso K. Ribeiro, Expedito Kalil-Filho, Roberto Edelman, Elazer R. Serruys, Patrick W. Lemos, Pedro A. |
| author_sort | Mariani, José |
| collection | MIT |
| description | 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. |
| first_indexed | 2024-09-23T12:39:44Z |
| format | Article |
| id | mit-1721.1/102986 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T12:39:44Z |
| publishDate | 2016 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | mit-1721.1/1029862022-10-01T10:21:35Z Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial Mariani, José Guedes, Cristiano Soares, Paulo Zalc, Silvio Campos, Carlos M. Lopes, Augusto Celso de Araujo Spadaro, André G. Perin, Marco A. Filho, Antonio Esteves Takimura, Celso K. Ribeiro, Expedito Kalil-Filho, Roberto Edelman, Elazer R. Serruys, Patrick W. Lemos, Pedro A. Institute for Medical Engineering and Science Lopes, Augusto Celso de Araujo Edelman, Elazer R. 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. National Institutes of Health (U.S.) (NIH grant R01 GM49039) Conselho Nacional de Pesquisas (Brazil) (Grant) Sociedade Brasileira de Cardiologia (SBC) (Arie Fellowship) 2016-06-06T16:29:32Z 2016-06-06T16:29:32Z 2014-10 2014-04 Article http://purl.org/eprint/type/JournalArticle 19368798 http://hdl.handle.net/1721.1/102986 Mariani Jr., Jose, Cristiano Guedes, Paulo Soares, Silvio Zalc, Carlos M. Campos, Augusto C. Lopes, Andre G. Spadaro, Marco A. Perin, Anotonio Esteves Filho, Celso K. Takimura, Expedito Ribeiro, Roberto Kalil-Filho, Elazer R. Edelman, Patrick W. Serruys, and Pedro A. Lemos. "Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention : The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial." JACC: Cardiovascular Interventions, 7:11 (November 2014), pp. 1287-1293. https://orcid.org/0000-0002-7832-7156 en_US http://dx.doi.org/10.1016/j.jcin.2014.05.024 JACC: Cardiovascular Interventions Creative Commons Attribution-NonCommercial-NoDerivs License http://creativecommons.org/licenses/by-nc-nd/4.0/ application/pdf Elsevier PMC |
| spellingShingle | Mariani, José Guedes, Cristiano Soares, Paulo Zalc, Silvio Campos, Carlos M. Lopes, Augusto Celso de Araujo Spadaro, André G. Perin, Marco A. Filho, Antonio Esteves Takimura, Celso K. Ribeiro, Expedito Kalil-Filho, Roberto Edelman, Elazer R. Serruys, Patrick W. Lemos, Pedro A. Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial |
| title | Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial |
| title_full | Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial |
| title_fullStr | Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial |
| title_full_unstemmed | Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial |
| title_short | Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial |
| title_sort | intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention the mozart minimizing contrast utilization with ivus guidance in coronary angioplasty randomized controlled trial |
| url | http://hdl.handle.net/1721.1/102986 https://orcid.org/0000-0002-7832-7156 |
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