Clinical Outcomes of Ivus-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease: A Prospective Comparative Study

Background:Patients with chronic kidney disease undergoing percutaneous coronary intervention are at increased risk of contrast-associated acute kidney injury and adverse cardiovascular events. Intravascular ultrasound guidance may improve procedural optimization and reduce contrast exposure compared with conventional angiography-guided PCI.Methods:This prospective comparative study included 158 patients with chronic kidney disease and significant coronary artery disease requiring PCI. Patients were divided into two groups: IVUS-guided PCI group (n=79) and angiography-guided PCI group (n=79). Baseline demographic, clinical, renal, cardiac, angiographic, procedural, and follow-up outcome data were recorded. The primary outcome was contrast-associated acute kidney injury, defined as an absolute rise in serum creatinine of ≥0.3 mg/dL or a relative increase of ≥50% from baseline within 48–72 hours after contrast exposure. Secondary outcomes included contrast volume, procedural success, worsening renal function, need for dialysis, length of hospital stay, and major adverse cardiac events.Results:Baseline demographic, renal, cardiac, and angiographic characteristics were comparable between the two groups. The mean contrast volume was significantly lower in the IVUS-guidedPCI group compared with the angiography-guided PCI group (72.4 ± 22.6 mL vs 108.7 ± 31.5 mL; p<0.001). The incidence of contrast-associated acute kidney injury was significantly lower in the IVUS-guided PCI group (5.1% vs 15.2%; p=0.034). Worsening renal function was also lower in the IVUS-guided group (7.6% vs 19.0%; p=0.035), and hospital stay was shorter (4.2 ± 1.4 days vs 5.1 ± 2.0 days; p=0.001). Follow-up major adverse cardiac events were significantly lower in the IVUS-guided group compared with theangiography-guided group (6.3% vs 17.7%; p=0.028).Conclusion:IVUS-guided PCI was associated with lower contrast use, reduced contrast-associated acute kidney injury, better renal outcomes, shorter hospital stay, and lower follow-up major adverse cardiacevents compared with angiography-guided PCI in patients with chronic kidney disease. IVUS-guided PCI may be considered a safer and more effective revascularization strategy in CKD patients, particularly in those at high risk of contrast-related renal injury.