Optimization of percutaneous coronary intervention (PCI) in complex coronary lesions remains a relevant clinical challenge. The IVUS-CHIP study was designed to evaluate whether a systematic IVUS-guided strategy with prespecified optimization criteria could reduce clinical events compared with conventional angiography in patients undergoing complex PCI.
This was a randomized, multicenter clinical trial with a 1:1 allocation ratio that enrolled 2,020 patients with silent ischemia, stable angina, unstable angina, or non-ST-segment elevation acute coronary syndrome, all presenting with complex coronary lesions. Complexity criteria included severe calcification, ostial lesions, true bifurcations with side 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 male, with a high prevalence of cardiovascular risk factors and a preserved left ventricular 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 failed to demonstrate a significant reduction in the primary endpoint compared with angiography-guided PCI. Target vessel failure occurred in 13.9% of patients in the IVUS group versus 11.1% in the angiography group (HR 1.25; 95% CI 0.97–1.60). No significant differences were observed in the individual components of the primary endpoint or in most secondary endpoints.
Read also: ACC 2026 | ALL-RISE Trial: Coronary Physiological Assessment Using FFRangio.
However, IVUS use was associated with a lower incidence of definite stent thrombosis (0.2% vs. 1.0%; HR 0.20; 95% CI 0.04–0.90) and definite or probable stent thrombosis (0.5% vs. 1.5%; HR 0.33; 95% CI 0.12–0.90).
Conclusion
In patients undergoing high-risk complex PCI, a systematic IVUS-guided strategy did not significantly reduce the incidence of target vessel failure compared with conventional angiographic guidance.
Original Title: Intravascular Ultrasound Guided or Angiography Guided Complex High-Risk PCI (IVUS-CHIP Trial).
Subscribe to our weekly newsletter
Get the latest scientific articles on interventional cardiology
 en lesiones complejas continúa siendo un desafío clínico relevante.){kind=link}