Target vessel failure reduced after intravascular imaging- vs. angiography-guided PCI
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Key takeaways:
- The RENOVATE-COMPLEX-PCI trial supports the use of intravascular imaging-guided PCI for the treatment of complex coronary artery lesions.
- Intravascular imaging-guided PCI was associated with lower risk for target vessel failure vs. angiography-guided PCI at 3-year follow-up.
NEW ORLEANS — Intravascular imaging-guided PCI was associated with lower risk for target vessel failure vs. angiography-guided PCI for the treatment of complex coronary artery lesions, a speaker reported.
The results of the RENOVATE-COMPLEX-PCI trial were presented at the American College of Cardiology Scientific Session and simultaneously published in The New England Journal of Medicine.
Data were derived from Lampert R, et al. Late-Breaking Clinical Trials V. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
“Previous trials have shown lower rates of the major adverse clinical events after IVUS-guided PCI than after angiography-guided PCI, but have not been considered definitive owing to limited simple size, relatively short follow-up duration or inclusion of highly selected coronary lesion subsets,” Joo-Yong Hahn, MD, PhD, professor of cardiology and medicine at Sungkyunkwan University School of Medicine in Seoul, South Korea, said during a presentation.
Therefore, Hahn and colleagues conducted the prospective, randomized, open-label, multicenter RENOVATE-COMPLEX-PCI trial to evaluate whether intravascular imaging-guided PCI (Opticross, Boston Scientific or Dragonfly, Abbott Vascular) reduced TVF compared with angiography-guided PCI for patients with complex coronary artery lesions.
A total of 1,620 patients were randomly assigned 2:1 to intravascular imaging- (IVUS or OCT) or angiography-guided PCI and followed up for 1 year after last patient enrollment (mean age, 66 years; 79% men). Approximately half of the total cohort had an initial presentation of stable ischemic heart disease and the other half presented with ACS. The primary endpoint was TVF, defined as cardiac death, target vessel-related MI and target vessel revascularization.
During median follow-up of 2.1 years, TVF occurred in 7.7% of patients assigned to intravascular imaging-guided PCI compared with 12.3% of patients assigned to angiography-guided PCI (HR = 0.64; 95% CI, 0.45-0.89; P = .008).
The researchers noted that TVF excluding procedural MI occurred in 5.1% of patients assigned to intravascular imaging-guided PCI compared with 8.7% of patients assigned to angiography-guided PCI (HR = 0.59; 95% CI, 0.39-0.9).
Compared with the angiography group, the intravascular imaging group also had reduced risk for target vessel-related MI or cardiac death (5.3% vs. 8.5%; HR = 0.63; 95% CI, 0.42-0.93) and death from cardiac causes (1.7% vs. 3.8%; HR = 0.47; 95% CI, 0.24-0.93), according to the researchers.
In addition, the treatment effects of intravascular imaging-guided PCI compared with angiography-guided PCI were consistent across all prespecified subgroups, according to the presentation.
The researchers observed no significant difference in the rate of TVF between patients who underwent intravascular imaging-guided PCI with IVUS compared with OCT.
“Among patients with complex coronary artery lesions, intravascular imaging-guided PCI reduced the composite of cardiac death, target vessel-related myocardial infarction or clinically driven target vessel revascularization compared to angiography-guided PCI,” Hahn said. “Our results support intravascular imaging-guided PCI in patients with complex coronary lesions.”
Reference:
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Hahn JY, et al. Joint American College of Cardiology/New England Journal of Medicine Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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