TOPLINE:

Patients with complex coronary artery lesions who underwent percutaneous coronary intervention (PCI) guided by intravascular imaging rather than angiography had a lower risk for a composite of cardiac death and heart attack related to the treated vessel and a less need for repeat procedures over a 5-year follow‑up.

METHODOLOGY:

• Researchers reported findings from an extended follow-up of a prospective, randomized, open-label trial (RENOVATE‑COMPLEX‑PCI) that compared outcomes of intravascular imaging-guided vs angiography-guided PCI in patients with complex coronary artery lesions.
• They included 1639 patients with complex coronary artery lesions at 20 hospitals in South Korea between May 2018 and May 2021. Mean age of patients was 65.6 years, and 79.3% were men.
• Patients were randomly assigned to undergo PCI guided by either intravascular imaging (n = 1092) or angiography (n = 547), all receiving second‑generation everolimus‑eluting stents with standard care.
• In the intravascular imaging-guided arm, operators used intravascular ultrasound or optical coherence tomography before and after stenting to ensure the stent fits correctly and to detect any edge problems. The angiography-guided arm relied on the visual criteria alone.
• The primary endpoint was target vessel failure, a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization, assessed over a median follow-up of 5.3 years.

TAKEAWAY:

• Target vessel failure occurred in fewer patients who underwent PCI guided by intravascular imaging vs angiography (10.5% vs 14.9%), corresponding to a 32% lower risk (P = .009).
• Cardiac death or target vessel-related myocardial infarction occurred in fewer patients in the intravascular imaging-guided arm than those in the angiography-guided arm (7.6% vs 10.7%), corresponding to a 32% lower risk (P = .029).
• Definite stent thrombosis affected one patient (0.1%) in the intravascular imaging-guided arm vs four patients (0.7%) in the angiography-guided arm, corresponding to an 83% lower risk (P = .036).
• Imaging guidance added about 15 minutes to the procedure time, and rates of procedure-related complications remained similar between the two arms.

IN PRACTICE:

“[The] trial supports the use of intravascular imaging-guided PCI to improve long-term clinical outcomes of patients with complex coronary artery lesions,” the researchers of the study wrote.

SOURCE:

The study was jointly led by Joo Myung Lee, MD, MPH, PhD, and Onyou Kim, MD, of Sungkyunkwan University School of Medicine in Seoul, South Korea. It was published online on March 4 in JACC.

LIMITATIONS:

The extended follow‑up was not prespecified, which may have introduced bias. More than half of patients came from one center, and all were East Asian, limiting broader generalizability. The study was open label and did not systematically record quantitative angiography for untreated lesions or detailed medication use during follow‑up.

DISCLOSURES:

The trial received grant support from Abbott Vascular and Boston Scientific. Three authors reported receiving institutional research grants from various Korean organizations and pharmaceutical and healthcare companies, including the funding agencies. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.