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Yangsoo Jang, M.D. Ph. D On behalf of CTO-IVUS investigator

Clinical impact of IVUS- guided CTO intervention on the clinical outcomes after new generation DES implantation; Randomized CTO-IVUS study. Yangsoo Jang, M.D. Ph. D On behalf of CTO-IVUS investigator. Division of Cardiology, Severance Cardiovascular Hospital

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Yangsoo Jang, M.D. Ph. D On behalf of CTO-IVUS investigator

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  1. Clinical impact of IVUS-guided CTO intervention on the clinical outcomes after new generation DES implantation; Randomized CTO-IVUS study Yangsoo Jang, M.D. Ph. D On behalf of CTO-IVUS investigator Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine, Seoul, Korea

  2. Study at a glance and flow chart Total 467 patients with CTO were initially screened • Exclusion • Wiring failure ; 61 patients • Refusal of study enrollment ; 4 patients A total of 402 patients were finally enrolled after successful guidewire-crossing 1:1 randomization IVUS-guided group (n=201) Angiography-guided group (n=201) 1:1 randomization R-ZES vs. N-BES Clinical follow-up for 12 months # Primary endpoint; Composite of Cardiac death, MI, & TVR at 12 months

  3. Primary endpoint (Cardiac death, MI, TVR) 10 (No. of events) Angiography-guided group 8 7.1% (14) IVUS-guided group HR=0.35, 95% CI = 0.13 – 0.97 p = 0.035 6 12-month Cumulative incidence (%) 4 2.6% (5) 2 0 0 3 6 9 12 Follow-up duration (months) Number at risk Angiography-guided 201 198 179 201 198 186 IVUS-guided

  4. Cardiac death or MI TVR Angiography-guided group 10 10 IVUS-guided group 8 8 HR=0.48, 95% CI = 0.17–1.42 p = 0.186 *p = 0.045 6 6 5.2% (10) 12-month Cumulative incidence (%) 4 4 2.6% (5) 2.0% (4) 2 2 0% (0) 0 0 12 0 3 6 9 12 0 3 6 9 Follow-up duration (months) Follow-up duration (months) Number at risk 201 198 187 201 199 180 Angiography-guided 201 199 201 IVUS-guided 190 198 186 *Not calculable HR or CI because of no occurrence of the event

  5. Summary ofCTO-IVUS study • This CTO-IVUS study is the first randomized trial investigating the clinical benefits of IVUS guidance for CTO intervention after successful guidewire crossing in the era of new generation DES. • This study demonstrated that … • As compared to conventional angiography-guided CTO intervention, IVUS-guided CTO intervention • caused a more frequent use of high-pressure post-dilation and a larger post-procedural MLD • finally, significantly improved clinical outcomes after DES implantation

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