Intravascular Imaging-Guided PCI vs Coronary Artery Bypass Grafting for Left Main or 3-Vessel Disease
Sang Yoon Lee1, Yang Hyun Cho2, Kiick Sung2
1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Intravascular imaging-guided percutaneous coronary intervention (PCI) showed comparable clinical outcomes to coronary artery bypass graft (CABG) for complex coronary artery disease. This approach may offer a safer alternative to standard PCI when compared with CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass graft (CABG) historically offers superior outcomes to percutaneous coronary intervention (PCI) for left main or 3-vessel coronary artery disease.
- The role of intravascular imaging (IVI) in guiding PCI for these complex cases remains less understood compared to CABG.
Purpose of the Study:
- To compare the clinical outcomes of IVI-guided PCI versus CABG in patients with left main or 3-vessel coronary artery disease.
- To evaluate if IVI guidance can mitigate the potential disparities in clinical events between PCI and CABG.
Main Methods:
- Analysis of 6,962 patients from the RENOVATE-COMPLEX-PCI trial and Samsung Medical Center registry.
- Primary outcome: composite of all-cause death, nonfatal myocardial infarction, or stroke at 3 years.
- Comparison groups: IVI-guided PCI, angiography-guided PCI, and CABG, with propensity score-matched analysis.
Main Results:
- Overall PCI showed a higher risk of the primary outcome compared to CABG (13.3% vs 10.8%).
- However, IVI-guided PCI demonstrated comparable risk to CABG (8.7% vs 10.8%, P=0.058).
- Propensity score-matched analysis confirmed similar outcomes between IVI-guided PCI and CABG (9.5% vs 9.4%, P=0.914).
Conclusions:
- PCI, in general, was associated with a higher risk of major adverse cardiovascular events than CABG for complex coronary artery disease.
- IVI-guided PCI, however, yielded comparable clinical event rates to CABG.
- These findings suggest IVI-guided PCI may be a viable alternative to CABG in select patients with complex coronary artery disease.
Background:
Previous trials have shown that coronary artery bypass graft (CABG) has better clinical outcomes compared with percutaneous coronary intervention (PCI) for patients with left main coronary artery or 3-vessel disease. However, it is unclear whether intravascular imaging (IVI)-guided PCI would reduce the difference in clinical events compared to CABG.
Objectives:
The present study sought to compare the clinical outcomes of patients with left main or 3-vessel disease who underwent IVI-guided PCI with those who underwent CABG.
Methods:
A total of 6,962 patients with left main or 3-vessel disease from the RENOVATE-COMPLEX-PCI trial (n = 1,639) and the institutional registry of Samsung Medical Center (2,972 patients underwent PCI and 6,600 patients underwent CABG) were analyzed. The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or stroke at 3 years.
Results:
Among the study population, 848 patients underwent IVI-guided PCI, 987 patients underwent angiography-guided PCI, and 5,127 patients underwent CABG. Patients treated with PCI had significantly higher risk of primary outcome than patients who underwent CABG (13.3% vs 10.8%; HR: 1.23; 95% CI: 1.05-1.44; P = 0.013). However, the risk of primary outcome was comparable between IVI-guided PCI and CABG (8.7% vs 10.8%; HR: 0.77; 95% CI: 0.59-1.01; P = 0.058). The propensity score-matched analysis showed similar results between IVI-guided PCI and CABG (9.5% vs 9.4%; HR: 0.98; 95% CI: 0.69-1.40; P = 0.914).
Conclusions:
In this hypothesis-generating study, PCI had significantly higher risk of a composite of death, nonfatal myocardial infarction, or stroke than CABG. However, IVI-guided PCI had comparable risk of clinical events compared with CABG. (Intravascular Imaging- Versus Angiography-Guided Percutaneous Coronary Intervention For Complex Coronary Artery Disease [RENOVATE-COMPLEX-PCI], NCT03381872; Institutional cardiovascular catheterization database of Samsung Medical Center (Long-Term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI, NCT03870815; Institutional coronary artery bypass grafting database of Samsung Medical Center (Long-Term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI, NCT03870815).
More Related Videos
05:25Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:27Coronary Artery Disease V: Interprofessional Care
01:28Imaging Studies for Cardiovascular System V: CT
01:27Peripheral Artery Disease III: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiac Catheterization I: Pre-Procedure Overview