Intravascular Imaging-Guided Percutaneous Coronary Intervention Before and After Standardized Optimization Protocols.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Technology Assessment

Background:

• Previous studies suggested benefits of intravascular imaging (IVI) in percutaneous coronary intervention (PCI).
• The impact of contemporary practice changes, particularly standardized optimization protocols, on IVI-guided PCI outcomes remained unclear.

Purpose of the Study:

• To evaluate if clinical outcomes of IVI-guided PCI differ before and after implementing standardized optimization protocols.
• To compare IVI-guided PCI with angiography-guided PCI in complex coronary artery disease.

Main Methods:

• Retrospective analysis of 2,972 patients (past group, 2008-2015, before protocols) and 1,639 patients (present group, 2018-2021, after protocols).
• Patients were categorized by IVI guidance versus angiography guidance.
• Primary outcome: 3-year target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization.

Main Results:

• IVI-guided PCI significantly reduced TVF compared to angiography-guided PCI (10.0% vs 6.7%; P=0.027).
• The 'present' IVI group (after protocols) showed significantly lower TVF than the 'past' IVI group (5.1% vs 8.5%; P=0.025).
• Reduced target vessel revascularization drove the improved outcomes in the 'present' IVI group.

Conclusions:

• IVI-guided PCI offers superior clinical outcomes compared to angiography-guided PCI.
• The application of standardized optimization protocols in IVI use further improves post-PCI clinical outcomes.
• Findings support the routine adoption of IVI with optimization protocols for complex PCI.