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Updated: Jul 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Intravascular Imaging in Patients With Complex Coronary Lesions and Chronic Kidney Disease
Woochan Kwon1, Ki Hong Choi1, Young Bin Song1
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Intravascular imaging guidance significantly reduced target vessel failure in patients undergoing complex percutaneous coronary intervention, regardless of chronic kidney disease (CKD) presence. Greatest benefits were seen in stage 3 CKD patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Nephrology
Background:
- Patients with chronic kidney disease (CKD) often present with complex coronary lesions, necessitating percutaneous coronary intervention (PCI).
- Intravascular imaging guidance may offer benefits in optimizing PCI for complex lesions, particularly in the high-risk CKD population.
Purpose of the Study:
- To determine if outcomes following intravascular imaging-guided PCI differ based on the presence or absence of CKD.
- To evaluate the efficacy of intravascular imaging versus traditional angiography in guiding PCI for complex coronary lesions in patients with and without CKD.
Main Methods:
- A prespecified substudy of the RENOVATE-COMPLEX-PCI randomized clinical trial.
- 1639 patients with complex coronary lesions were stratified into CKD (296) and non-CKD (1343) groups.
- PCI was performed using either intravascular imaging guidance or conventional angiography guidance.
Main Results:
- Intravascular imaging guidance significantly reduced the primary endpoint of target vessel failure (TVF) at 3 years in both CKD (13.3% vs 23.3%) and non-CKD (6.4% vs 9.9%) groups.
- The reduction in TVF was primarily driven by decreased cardiac death or target vessel-related myocardial infarction in the CKD group and by target vessel revascularization in the non-CKD group.
- Patients with moderate CKD (GFR 30-60 mL/min/1.73m²) showed the greatest benefit from imaging-guided PCI (8.8% vs 21.2%).
Conclusions:
- Intravascular imaging guidance provides significant clinical benefits over angiography alone for complex PCI, irrespective of CKD status.
- The study highlights the particular advantage of imaging guidance in patients with stage 3 CKD, suggesting tailored approaches for this population.
- ClinicalTrials.gov Identifier: NCT03381872.
Importance:
As patients with chronic kidney disease (CKD) are more likely to have complex coronary lesions, intravascular imaging guidance in percutaneous coronary intervention (PCI) for this population could be potentially beneficial.
Objectives:
To investigate whether the outcomes of intravascular imaging-guided procedural optimization would be different according to the presence of CKD.
Design, Setting, And Participants:
This was a prespecified substudy of RENOVATE-COMPLEX-PCI, a recently published multicenter randomized clinical trial in Korea studying the benefits of intravascular imaging for complex coronary lesions. Patients with complex coronary lesions, with or without CKD, were enrolled between May 2018 and May 2021. Data were analyzed from January to June 2023.
Interventions:
PCI in each group was done either under the guidance of intravascular imaging or angiography alone.
Main Outcomes And Measures:
The primary end point was target vessel failure (TVF) at the 3-year point, defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.
Results:
A total of 1639 patients (1300 male [79.3%]) treated with PCI for complex coronary lesions were stratified into CKD (296 participants) and non-CKD (1343 participants) groups. The mean (SD) age of each group was 70.3 (9.4) and 64.5 (10.1) years, and mean (SD) estimated serum creatinine was 2.9 (5.3) and 0.8 (0.2) mg/dL for CKD and non-CKD groups, respectively. Intravascular imaging-guided revascularization was associated with significantly lower incidence of the primary end point compared with angiography-guided revascularization in both CKD (13.3% vs 23.3%; hazard ratio [HR], 0.51; 95% CI, 0.27-0.93; P = .03) and non-CKD (6.4% vs 9.9%; HR, 0.66; 95% CI, 0.44-0.99; P = .05) groups. The significantly lower incidence of the primary end point was mainly associated with the lower risk of cardiac death or target vessel-related myocardial infarction (9.4% vs 22.2%; HR, 0.39; 95% CI, 0.20-0.76; P = .006) in the CKD group and by target vessel revascularization (3.0% vs 5.5%; HR, 0.55; 95% CI, 0.30-0.99; P = .05) in the non-CKD group. Those with a glomerular filtration rate of at least 30 mL/min/1.73m2 and less than 60 ml/kg/1.73m2 showed the greatest benefit from imaging-guided complex PCI (8.8% vs 21.2%; HR, 0.28; 95% CI, 0.11-0.68; P = .02).
Conclusions And Relevance:
In this prespecified cohort substudy of the Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention trial, intravascular imaging guidance showed clinical benefit over angiography guidance in reducing the risk of TVF, regardless of the presence of CKD. The greatest benefits of imaging-guided complex PCI were observed in stage 3 CKD.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03381872.
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