Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Intravascular imaging-guided percutaneous coronary intervention (PCI) improves outcomes for complex coronary lesions over angiography-guided PCI.
• The prognostic significance of suboptimal intravascular imaging findings (stent underexpansion, malapposition, dissection) with modern drug-eluting stents remains unclear.

Purpose of the Study:

• To evaluate the impact of suboptimal intravascular imaging findings on clinical outcomes after PCI in complex coronary lesions.
• To determine the prognostic value of minimum stent area (MSA) and other imaging parameters in predicting target lesion failure (TLF).

Main Methods:

• Analysis of data from the RENOVATE-COMPLEX-PCI trial comparing imaging-guided vs. angiography-guided PCI.
• Assessment of post-PCI intravascular imaging findings (MSA, stent underexpansion, malapposition, dissection) in 897 nonleft main lesions.
• Primary endpoint was target lesion failure (TLF), including cardiac death, MI, revascularization, or stent thrombosis.

Main Results:

• An optimal MSA cutoff of 5.5 mm² was identified; MSA < 5.5 mm² significantly increased TLF risk (4.8% vs. 2.2%).
• Patients with MSA ≥ 5.5 mm² but suboptimal imaging findings had a numerically increased TLF risk (3.2%).
• Patients with MSA < 5.5 mm² and suboptimal findings had a significantly increased TLF risk (4.7%).

Conclusions:

• Inadequate absolute stent expansion (MSA < 5.5 mm²) after intravascular imaging-guided PCI for complex lesions is an independent predictor of higher TLF.
• Suboptimal post-PCI intravascular imaging findings, including relative stent underexpansion, malapposition, and dissection, appear to contribute to TLF risk.