Optimization of percutaneous coronary intervention (PCI) in complex lesions remains a relevant clinical challenge. In this context, the IVUS-CHIP trial was designed to evaluate whether a systematic IVUS-guided strategy, with prespecified optimization criteria, reduces clinical events compared with conventional angiography in patients undergoing complex PCI.
This was a randomized, multicenter clinical trial with 1:1 allocation that included 2,020 patients with silent ischemia, stable or unstable angina, or non–ST-elevation acute coronary syndrome, all with complex coronary lesions. Complexity features included severe calcification, ostial lesions, true bifurcations with branches >2.5 mm, left main coronary artery disease, chronic total occlusions, in-stent restenosis, and long lesions (>28 mm). Patients were assigned to IVUS-guided PCI (n=1,010) or angiography-guided PCI (n=1,010). The mean age was 69 years, 80% were men, with a high prevalence of cardiovascular risk factors and a preserved ejection fraction of approximately 52–53%.
The primary endpoint was target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target vessel revascularization.
The IVUS-guided strategy demonstrated a significant reduction in the primary endpoint compared with angiography-guided PCI alone. Target vessel failure was lower in the IVUS group (≈7–8%) versus the angiography group (≈10–11%), with a relative reduction of approximately 25–30%.
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This difference was mainly driven by a decrease in ischemic events related to the target vessel, particularly a lower need for repeat revascularization and a reduced incidence of target vessel–related myocardial infarction, without a significant increase in periprocedural complications.
Conclusion: Systematic IVUS optimization improves outcomes in complex coronary disease without increasing complications
In conclusion, the IVUS-CHIP trial shows that, in patients with complex coronary artery disease undergoing PCI, a systematic IVUS-guided strategy is associated with a significant reduction in major clinical events compared with conventional angiography.
Original Title: Intravascular Ultrasound Guided or Angiography Guided Complex High-Risk PCI (IVUS-CHIP Trial).
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