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.
abstract: OBJECTIVE
  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).
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Mariani
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Guedes
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Soares
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Silvio
authors.initials: S
authors.lastname: Zalc
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Campos
authors.affiliation: Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Lopes
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: André G
authors.initials: AG
authors.lastname: Spadaro
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Perin
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Antonio Esteves
authors.initials: AE
authors.lastname: Filho
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Celso K
authors.initials: CK
authors.lastname: Takimura
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Expedito
authors.initials: E
authors.lastname: Ribeiro
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil-Filho
authors.affiliation: 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.
authors.forename: Elazer R
authors.initials: ER
authors.lastname: Edelman
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Imperial College London, London, United Kingdom.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. Electronic address: pedro.lemos@incor.usp.br.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000009:adverse effects; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C038192:iopromide; D003404:Creatinine; C044834:iodixanol
keywords: contrast; coronary intravascular ultrasound; renal failure; stent