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Joo Myung Lee1, Ki Hong Choi1, Young Bin Song1

  • 1From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea.

The New England Journal of Medicine
|March 6, 2023
PubMed
Summary

Intravascular imaging guidance for percutaneous coronary intervention (PCI) in complex lesions significantly reduced major adverse cardiac events compared to angiography guidance. This approach offers improved outcomes for patients with complex coronary artery disease.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Limited data exists on clinical outcomes comparing intravascular imaging-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for complex coronary artery lesions.
  • Complex coronary artery lesions pose a significant challenge in interventional cardiology.

Purpose of the Study:

  • To compare the clinical outcomes of intravascular imaging-guided PCI versus angiography-guided PCI in patients with complex coronary artery lesions.
  • To evaluate the efficacy and safety of advanced imaging techniques in complex PCI procedures.

Main Methods:

  • A prospective, multicenter, open-label trial randomized 1639 patients with complex coronary artery lesions.
  • Patients were assigned 2:1 to intravascular imaging-guided PCI (using IVUS or OCT) or angiography-guided PCI.
  • The primary endpoint was a composite of cardiac death, target-vessel MI, or clinically driven target-vessel revascularization, with a median follow-up of 2.1 years.

Main Results:

  • Intravascular imaging-guided PCI showed a significantly lower cumulative incidence of the primary endpoint (7.7%) compared to angiography-guided PCI (12.3%) (HR, 0.64; P=0.008).
  • Specific event rates for cardiac death, target-vessel MI, and revascularization were lower in the imaging group.
  • No significant differences in procedure-related safety events were observed between the groups.

Conclusions:

  • Intravascular imaging-guided PCI is superior to angiography-guided PCI in reducing major adverse cardiac events for patients with complex coronary artery lesions.
  • The study supports the routine use of intravascular imaging in complex PCI to improve patient outcomes.
  • No compromise in safety was noted with the use of intravascular imaging guidance.