IVUS-Guided versus Angiography-Guided PCI in Unprotected Left Main Coronary Disease

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Percutaneous coronary intervention (PCI) is a common treatment for unprotected left main coronary artery disease.
• The effectiveness of intravascular ultrasonography (IVUS) guidance in PCI for this condition compared to traditional angiography remains unclear.

Purpose of the Study:

• To determine if IVUS-guided PCI offers improved clinical outcomes compared to angiography-guided PCI in patients with unprotected left main coronary artery disease.

Main Methods:

• An international, multicenter, open-label trial randomized 806 patients with unprotected left main coronary artery disease.
• Patients were assigned 1:1 to either IVUS-guided PCI or angiography-guided PCI.
• The primary endpoint was a composite of stroke, myocardial infarction, revascularization, or death.

Main Results:

• At a median follow-up of 2.9 years, the primary endpoint occurred in 33.7% of the IVUS-guided group and 30.9% of the angiography-guided group (HR, 1.11; 95% CI, 0.87-1.42; P=0.40).
• Incidence of death, myocardial infarction, or revascularization was similar between the groups.
• Procedure-related and overall safety events were also comparable across both groups.

Conclusions:

• IVUS-guided PCI demonstrated no significant additional benefit over angiography-guided PCI for patients with unprotected left main coronary artery disease.
• Outcomes regarding stroke, myocardial infarction, revascularization, and death were similar between the two guidance methods at 2.9-year follow-up.