Key result
IVUS-guided PCI cuts 6-month ACS rates by an absolute ~27% compared to angiography alone.
Why the study?
The potential benefits of IVUS for optimizing stent implantation during PCI may be particularly relevant in diabetic patients with coronary artery disease, prompting this comparison of clinical and procedural outcomes between IVUS-guided and angiography-guided PCI.
Does IVUS-guided PCI with minimal contrast volume improve procedural parameters, reduce contrast-induced nephropathy and complications, and reduce 6-month acute coronary syndrome compared to angiography-guided PCI without IVUS in diabetic patients with non-ACS coronary artery disease?
Does IVUS-guided PCI with minimal contrast volume improve procedural parameters, reduce contrast-induced nephropathy and complications, and reduce 6-month acute coronary syndrome compared to angiography-guided PCI without IVUS in diabetic patients with non-ACS coronary artery disease?
In diabetic patients undergoing elective PCI, IVUS guidance was associated with reduced contrast volume, procedure duration, radiation exposure, contrast-induced nephropathy, access-site hematomas, and 6-month acute coronary syndrome compared to angiography guidance alone.
Answers are grounded in this paper and cite their sources.
May reduce nephropathy and events in diabetic PCI; hypothesis-generating, requires larger randomized confirmation before practice change.
Background: Intravascular ultrasound (IVUS) provides detailed assessment of coronary artery anatomy and facilitates optimization of stent implantation during percutaneous coronary intervention (PCI). Its potential benefits may be particularly relevant in diabetic patients with coronary artery disease. This study aimed to compare clinical and procedural outcomes of IVUS-guided PCI and angiography-guided PCI in diabetic patients. Methods: This study included 60 diabetic patients undergoing PCI. Patients were equally allocated into two groups: Group I underwent IVUS-guided PCI, while Group II underwent PCI without IVUS guidance. Clinical characteristics, laboratory parameters, procedural variables, complications, and follow-up outcomes were compared between the groups. Results: IVUS-guided PCI was associated with significantly lower contrast volume, radiation dose, fluoroscopy time, and total procedure time compared with PCI without IVUS guidance. Post-procedural creatinine and estimated glomerular filtration rate differed significantly between the groups. Hematoma and contrast-induced nephropathy occurred less frequently in the IVUS-guided group. No significant differences were observed in dissection, no-reflow, or coronary perforation. During six-month follow-up, acute coronary syndrome occurred more frequently in the group undergoing PCI without IVUS guidance. Conclusions: IVUS-guided PCI in diabetic patients was associated with lower contrast use, reduced procedural radiation exposure, shorter procedure duration, and fewer access-site hematomas and cases of contrast-induced nephropathy. These findings suggest potential procedural and clinical benefits of IVUS guidance in diabetic patients undergoing PCI.
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Ashmawy et al. (2026) studied Diabetes mellitus and coronary artery disease undergoing PCI (n=60). IVUS-guided percutaneous coronary intervention (PCI) with minimal contrast volume vs. Angiography-guided PCI without IVUS was evaluated on Acute coronary syndrome (ACS) at 6-month follow-up (p=0.024). IVUS-guided PCI significantly reduced 6-month acute coronary syndrome rates (16.7% vs 43.3%, p=0.024) and contrast-induced nephropathy (10.0% vs 33.3%, p<0.001) compared to PCI without IVUS.
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