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

It remains unknown whether intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) can improve the clinical outcomes of complex PCI to a level equivalent to that of non-complex PCI. In the OPTIVUS-Complex PCI (Optimal Intravascular Ultrasound-Guided Complex PCI) Study multivessel cohort, a total of 1011 patients who underwent multivessel PCI involving a target lesion in the left anterior descending coronary artery (LAD) were divided into 2 groups: complex PCI (N = 760) and non-complex PCI groups (N = 251). Complex PCI was defined as a procedure with the following characteristics: 3 vessels treated, 3 stents implanted, 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, or target of chronic total occlusion. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) defined by a composite of death, myocardial infarction, stroke, or any coronary revascularization. The cumulative 1-year incidences of the primary endpoint and any coronary revascularization were not significantly different between the complex and non-complex PCI groups (10.9% vs. 8.3%, P = 0.24, and 7.7% vs. 4.8%, P = 0.12, respectively). In the multivariable Cox proportional hazards models, there was no significant excess risk of the complex PCI group relative to the non-complex PCI group for the primary endpoint (HR, 1.35; 95%CI, 0.83-2.18; P = 0.22), or for any coronary revascularization (HR, 1.64; 95%CI, 0.87-3.06; P = 0.11). After optimal IVUS-guided multivessel PCI with a target lesion in the LAD, 1-year risk of MACCE or coronary revascularization in patients with complex PCI was numerically higher than that in patients with non-complex PCI.