Intravascular Ultrasound Guidance to Minimize the use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART Randomized Controlled Trial

SUMMARY :

Angiography requires the use of iodine contrast agent, and may cause contrast-induced acute kidney injury. The use of contrast is also potentiall y problematic in patients at risk of volume overload i.e. excess fluid in the blood. T he use of IVUS during coronary angioplasty should result in reduced patient exposure t o contrast. The Minimizing cOntrast utiliZAtion with IVUS guidance in coRonary angi oplasTy (MOZART) randomized controlled trial randomly assigned 83 patient s undergoing PCI to angiographic or IVUS guidance. 2 The clinical characteristics of patients in the two group s were similar; most had diabetes and many had long, calci fied, bifurcated, and complex lesions. Patients were followed up at an average of 4 months.

The IVUS-guided treatment arm had a threefold-reduced usage of contrast dose compared with the angiography arm (64.5 ml vs. 20.0 ml respectively, p <0.001). In addition, the impact of the procedure on the kidneys w as assessed by measuring the creatinine clearance, a widely used measure of renal fun ction. The median volume of contrast volume / creatinine clearance ratio was significa ntly lower among patients treated with IVUS-guided PCI (1.0 vs. 0.4 respectively; p <0.001). IVUS-guided PCI took significantly longer time compared with angiographic PC I, on average 14 minutes more (p = 0.006), most likely due to the time needed for acqu isition and interpretation of IVUS images. In-hospital and 4-month clinical outcomes were not different between patients who received angiography-guided and IVUS-guided PCI

In this study, the use of IVUS as the primary imaging t ool during PCI was safe and associated with reduced contrast use. A cost-effectivene ss study would be useful to determine whether the increased procedural cost of IVUS would be offset by the reduced contrast use and ultimate decrease in complicati ons. The authors concluded that ‘ IVUS imaging should be considered for patients at high risk for contrast-induced acute kidney injury or volume overload undergoing corona ry angioplasty. ’

ake-home message: IVUS guided PCI used less contrast agent than angiography-guided procedures, potentially protecting against renal injury

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References

1). Mariani J, Jr., Guedes C, Soares P, et al., Intravascular ultras ound 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, JACC Cardiovasc Interv, 2014 ;7:1287-93.