Patients with complex coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) have worse clinical outcomes tan patients with non-complex CAD. Several studies have shown that the use of intravascular imaging (IVUS, OCT) have reduced major adverse events vs. angiography guided PCI. However, these studies present limitations both of size, studied population, short term followup and selection bias.
The aim of this prospective, randomize, open label and multicenter study of superiority was to determine whether intravascular imaging guided PCI might improve clinical outcomes vs. angioplasty guided PCI in patients with complex CAD.
Primary end point was target vessel failure (TVF) defined as a composite of cardiac death, target vessel MI and clinically driven target vessel revascularization.
Researchers looked at 1639 patients randomized to intravascular imaging guided PCI N=1092) and angiography guided PCI (N=547). Mean age was 65 and patients were mostly men.
The most frequent clinical presentation was acute coronary syndrome (ACS) (50.8%), and unstable angina was the most prevalent (32.6%). Complex coronary lesions were defined as long lesions (54.8%), multivessel lesions (37.9%), bifurcations (21.9%), chromic total occlusions (19.5%), multiple stents (18.6%), ostial lesions (15.3%), instent restenosis (14.4%), severe calcification (14.1%) and unprotected left main PCI (11.7%). IVUS was used more often (74.5%).
Read also: ACC 2023 | TAVR in Low Risk Patients: 3-Year Outcomes.
TVF in the intravascular imaging guided PCI was 7.7% vs 12.3% in the angioplasty guided PCI (HR: 0.64; 95% CI, 0.45 – 0.89; P=0.008). When comparing OCT vs IVUS guided PCI, there were no differences in TVF at one year (P=0.248).
Conclusion
Among patient with complex CAD, the use of intravascular imaging guided PCI was associated with lower incidence of cardiac death, target vessel MI or clinically driven revascularization vs angioplasty guided PCI. The RENOVATE-COMPLEX-PCI supports the use of intravascular imaging guided PCI in the treatment of patients with complex CAD.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI. The RENOVATE-COMPLEX-PCI Trial.
Reference: Joo-Yong Hahn, MD, PhD et al.
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