title: Clinical Impact of Intravascular Ultrasound-Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation: Randomized Study.
abstract: BACKGROUND
  There have been no randomized studies comparing intravascular ultrasound (IVUS)-guided versus conventional angiography-guided chronic total occlusion (CTO) intervention using new-generation drug-eluting stent Therefore, we conducted a prospective, randomized, multicenter trial designed to test the hypothesis that IVUS-guided CTO intervention is superior to angiography-guided intervention.
  
  
  RESULTS
  After successful guidewire crossing, 402 patients with CTOs were randomized to the IVUS-guided group (n=201) or the angiography-guided group (n=201) and secondarily randomized to Resolute zotarolimus-eluting stents or Nobori biolimus-eluting stents. The primary and secondary end points were cardiac death and a major adverse cardiac event defined as the composite of cardiac death, myocardial infarction, or target-vessel revascularization, respectively. After 12-month follow-up, the rate of cardiac death was not significantly different between the IVUS-guided group (0%) and the angiography-guided group (1.0%; P by log-rank test=0.16). However, major adverse cardiac event rates were significantly lower in the IVUS-guided group than that in the angiography-guided group (2.6% versus 7.1%; P=0.035; hazard ratio, 0.35; 95% confidence interval, 0.13-0.97). Occurrence of the composite of cardiac death or myocardial infarction was significantly lower in the IVUS-guided group (0%) than in the angiography-guided group (2.0%; P=0.045). The rates of target-vessel revascularization were not significantly different between the 2 groups. In the comparison between Resolute zotarolimus-eluting stent and Nobori biolimus-eluting stent, major adverse cardiac event rates were not significantly different (4.0% versus 5.7%; P=0.45).
  
  
  CONCLUSIONS
  Although IVUS-guided CTO intervention did not significantly reduce cardiac mortality, this randomized study demonstrated that IVUS-guided CTO intervention might improve 12-month major adverse cardiac event rate after new-generation drug-eluting stent implantation when compared with conventional angiography-guided CTO intervention.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01563952.
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Hun Sik
authors.initials: HS
authors.lastname: Park
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Je Sang
authors.initials: JS
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Seung-Jin
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Hee-Yeol
authors.initials: HY
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Bum-Kee
authors.initials: BK
authors.lastname: Hong
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Woong-Chol
authors.initials: WC
authors.lastname: Kang
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.).
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (B.-K.K., D.-H.S., M.-K.H., J.-S.K., Y.J.), Severance Biomedical Science Institute (M.-K.H., Y.J.), and Kangnam Severance Hospital (B.-K.H.), Yonsei University College of Medicine, Seoul, Korea; Kyungpook National University Hospital, Taegu, Korea (H.S.P.); Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Sejong General Hospital, Bucheon, Korea (J.S.K.); Soonchunhyang University Cheonan Hospital, Cheonan, Korea (S.-J.L.); Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea (H.-Y.K.); Gachon University Gil Hospital, Incheon, Korea (W.-C.K.); and Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.C.). jangys1212@yuhs.ac.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; C489443:zotarolimus; C518022:umirolimus; D020123:Sirolimus
keywords: coronary occlusion; drug-eluting stents; ultrasonography, interventional