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Published on: April 25, 2014
Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity
Sang Yoon Lee1, Seung-Jae Lee2, Woochan Kwon2
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) reduces target vessel failure in complex coronary artery lesions. The benefit of IVI-guided PCI increases with greater lesion complexity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) has demonstrated improved clinical outcomes compared to traditional angiography-guided PCI for complex coronary artery lesions.
- However, the influence of a patient's overall lesion complexity on the effectiveness of IVI-guided PCI remains an area requiring further investigation.
Purpose of the Study:
- To evaluate the impact of overall lesion complexity on the clinical benefits derived from IVI-guided PCI in patients with complex coronary artery lesions.
- To determine if the degree of lesion complexity modifies the effectiveness of IVI-guided PCI compared to angiography-guided PCI.
Main Methods:
- A combined analysis of 4,611 patients with complex coronary artery lesions from the RENOVATE-COMPLEX-PCI trial and the Samsung Medical Center registry.
- Patients were stratified based on the number of complex lesion features identified.
- The primary endpoint was target vessel failure (TVF) at 3 years, encompassing cardiac death, target vessel myocardial infarction, or target vessel revascularization.
Main Results:
- A threshold of 3 or more complex lesion features predicted a higher risk of TVF (11.0% vs 7.2%).
- IVI-guided PCI significantly reduced TVF risk in both low (<3 features) and high (≥3 features) complexity groups compared to angiography-guided PCI.
- A trend indicated that the risk reduction associated with IVI-guided PCI was more pronounced as the number of complex lesion features increased (interaction p=0.048).
Conclusions:
- IVI-guided PCI consistently lowers the risk of target vessel failure in patients with complex coronary artery lesions, irrespective of the degree of complexity.
- The prognostic advantage of employing IVI-guided PCI appears to be amplified in patients presenting with a higher number of complex coronary lesion features.
Background:
Recent trials have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) improves clinical outcome, as compared to angiography-guided PCI, in complex coronary artery lesions. However, it is unclear whether this benefit is affected by overall lesion complexity in each patient.
Aims:
The present study sought to investigate the impact of overall lesion complexity on the benefit of IVI-guided PCI.
Methods:
A total of 4,611 patients with complex coronary artery lesions from the RENOVATE-COMPLEX-PCI trial (n=1,639) and the institutional registry of the Samsung Medical Center (n=2,972) were classified according to the number of complex lesion features found in each patient. The primary outcome was target vessel failure (TVF) at 3 years, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularisation.
Results:
The cutoff value for the number of complex lesion features to predict TVF, determined using the maximally selected log-rank test, was 3. Patients with ≥3 complex lesion features had a higher risk of TVF than those with <3 complex lesion features (11.0% vs 7.2%, hazard ratio [HR] 1.59, 95% confidence interval [CI]: 1.28-1.96; p<0.001). IVI-guided PCI significantly reduced the risk of TVF compared with angiography-guided PCI in both groups (≥3 complex lesion features: 7.4% vs 14.4%, HR 0.49, 95% CI: 0.35-0.69; p<0.001; <3 complex lesion features: 5.7% vs 8.1%, HR 0.72, 95% CI: 0.53-0.98; p=0.039). The benefit of IVI-guided PCI tended to increase as the number of complex lesion features increased (absolute risk reduction for TVF: -0.012 vs -0.027 vs -0.055 vs -0.077, respectively, for 1 vs 2 vs 3 vs ≥4 complex lesion features; interaction p=0.048).
Conclusions:
In patients with complex coronary artery lesions, IVI-guided PCI showed a lower risk of TVF across all degrees of lesion complexity. The prognostic benefit of IVI-guided PCI tended to increase as patients had more complex lesion features. (RENOVATE-COMPLEX-PCI [ClinicalTrials.gov: NCT03381872]; Institutional cardiovascular catheterisation database of the Samsung Medical Center [ClinicalTrials.gov: NCT03870815]).
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