Prognostic impact of intravascular imaging in percutaneous coronary intervention according to procedural complexity

Data regarding intravascular imaging (IVI) in complex percutaneous coronary intervention (PCI) remain scarce.

In this study, we sought to assess the effects of IVI-guided PCI according to procedural complexity.

This was a post hoc analysis of the RENOVATE-COMPLEX-PCI trial that compared IVI-guided PCI with angiography-guided PCI in patients with complex coronary artery lesions. The study population was stratified into three groups of low, moderate, and high risk, according to PCI procedural complexity, following the European Society of Cardiology criteria. The high-risk group included patients meeting at least one clinical risk criterion and at least one procedural risk criterion. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularisation.

At a median 2.1-year follow-up, TVF risk increased significantly in a stepwise manner from the low (reference) to moderate (adjusted hazard ratio [HR] 1.369, 95% confidence interval [CI]: 0.705-2.660; p=0.353) and high procedural complexity group (adjusted HR 1.619, 95% CI: 0.963-2.723; p=0.069). The benefit of IVI-guided PCI varied by procedural complexity, with significant risk reductions in the moderate-risk group (adjusted HR 0.374, 95% CI: 0.150-0.935; p=0.035) and the high-risk group (adjusted HR 0.633, 95% CI: 0.424-0.945; p=0.025) but not in the low-risk group (adjusted HR 0.735, 95% CI: 0.282-1.914; p=0.528). The interaction between the IVI effect and procedural complexity was statistically significant (pinteraction=0.009).

In patients undergoing complex PCI, an IVI-guided procedure significantly reduced adverse cardiac events, with a greater magnitude of benefit observed in procedures of high complexity.