Intravascular ultrasound guidance to minimize the use of contrast in percutaneous coronary interventions in diabetic patients with chronic stable angina

Objective To evaluate the impact of Intravascular ultrasound guidance on the final volume of contrast agent utilized in diabetic patients undergoing PCI for chronic stable angina. Background To date, few approaches have been described to reduce the final dose of contrast agent in percutaneous coronary interventions (PCI). We hypothesized that intravascular ultrasound (IVUS) might serve as an adjuctive imaging tool in many steps during PCI, thereby reducing the use of iodine contrast. Methods A total of 100 Diabeic Egyptian patients were selected to angiography-guided PCI or IVUSguided PCI from June 2019 to January 2020 .The study type was case control and non consecutive . Both groups were treated according to a pre-defined meticulous procedural strategy. A written informed consent was taken from all patients.The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 6 months. Results The median total volume of contrast was 111.65 ml (interquartile range [IQR] 170.40 ± 52.91ml , range from 100 ml to 300 ml) in angiography-guided group vs. 56.99 ml (IQR 94.70 ± 19.28ml , range from 70 ml to 180 ml) in IVUS-guided group (p < 0.001).similary, the median total volume of contrast was 111.65 ml (interquartile range [IQR] 170.40 ± 52.91ml , range from 100 ml to 300 ml) in angiographyguided group vs. 56.99 ml (IQR 94.70 ± 19.28ml , range from 70 ml to 180 ml) in IVUS-guided group (p < 0.001).In-hospital and 6 month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI according to : Death, Acute myocardial infarction, Unplanned revascularization, Stent thrombosis. Conclusions Thoughtful and extensive utilization of IVUS as the primary imaging tool to guide PCI is safe, and markedly reduces the volume of iodine contrast, compared to angiography alone guidance.