Complex PCI and 1-year outcomes in the OPTIVUS-complex PCI study multivessel cohort

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Percutaneous coronary intervention (PCI) is a cornerstone of cardiovascular disease management.
• Complex PCI cases present unique challenges and may have different outcomes compared to simpler procedures.
• The role of intravascular ultrasound (IVUS) in optimizing complex PCI outcomes remains an area of investigation.

Purpose of the Study:

• To evaluate whether IVUS-guided complex PCI achieves clinical outcomes comparable to non-complex PCI.
• To assess the 1-year incidence of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing complex versus non-complex multivessel PCI.
• To determine if IVUS guidance can mitigate potential outcome disparities in complex PCI cases.

Main Methods:

• The OPTIVUS-Complex PCI study enrolled 1011 patients undergoing multivessel PCI targeting the left anterior descending (LAD) coronary artery.
• Patients were categorized into complex PCI (N=760) and non-complex PCI (N=251) groups based on procedural characteristics.
• Complex PCI criteria included: 3 vessels treated, 3 stents implanted, 3 lesions treated, bifurcation with 2 stents, total stent length >60 mm, or chronic total occlusion target.

Main Results:

• The 1-year cumulative incidence of MACCE was 10.9% in the complex PCI group versus 8.3% in the non-complex PCI group (P=0.24).
• The incidence of any coronary revascularization at 1 year was 7.7% for complex PCI and 4.8% for non-complex PCI (P=0.12).
• Multivariable analysis revealed no significant excess risk for MACCE (HR, 1.35; 95%CI, 0.83-2.18; P=0.22) or revascularization (HR, 1.64; 95%CI, 0.87-3.06; P=0.11) in the complex PCI group.

Conclusions:

• IVUS-guided multivessel PCI in the LAD did not demonstrate significantly different 1-year MACCE or revascularization rates between complex and non-complex PCI groups.
• While numerically higher, the risks associated with complex PCI were not statistically significant compared to non-complex PCI in this cohort.
• These findings suggest that IVUS guidance may help achieve comparable outcomes for complex PCI, although a trend towards higher events in complex cases was observed.