Real-World Evaluation of PCI Guidance Using Dynamic Coronary Roadmap: A DCR4Contrast Trial Secondary Analysis

Iodinated contrast used during percutaneous coronary intervention (PCI) risks contrast-induced acute kidney injury (CI-AKI). Reducing this risk is essential as PCI procedures become more complex. Dynamic Coronary Roadmap (DCR) is a PCI tool that overlays a virtual roadmap on fluoroscopy and has been shown to reduce contrast use.

This secondary analysis from the Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) study evaluates the feasibility of obtaining high-quality roadmaps suitable for PCI, its influence on contrast reduction and the relationship between PCI complexity and roadmap quality, and its effect on the contrast-sparing capabilities of DCR compared with standard angiographic guidance. The study was prospective and randomized, conducted in 6 centers across Europe (n = 3), Israel (n = 1), and the United States (n = 2). Patients were assigned to either DCR guidance or conventional guidance, and contrast usage and roadmap quality were compared.

The study included 365 patients (181 DCR and 184 control). Both groups were comparable in demographics and procedure characteristics. The DCR arm showed clinically usable roadmap quality in 97.2% of cases. Contrast volume was significantly lower with DCR guidance and lowest when the roadmap scored better: 63.5 ± 50.3 mL for "DCR good" (n = 147) vs 79.3 ± 42.8 mL for "DCR fair/poor" (n = 34) vs 90.2 ± 53.3 mL for "Control" (n = 184) (P < .001). DCR's efficacy increased with PCI complexity (using the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery [SYNTAX]) score of the treated vessel [SSv] as an index): 71.4% of first tertile (SSv < 4), 79.7% of second tertile (4 ≤ SSv < 8), and 93.1% of third tertile (SSv ≥ 8) scored "very good" or "good" (P < .05).

This multicenter study shows that DCR technology provides consistent high-quality roadmap support, reducing iodinated contrast usage significantly, particularly as PCI complexity increases.