Intravascular imaging-guided PCI shows benefit for left main CAD vs. angiography
Click Here to Manage Email Alerts
Key takeaways:
- Intravascular imaging-guided PCI demonstrated clinical benefit vs. angiography for left main CAD.
- Observed reductions in TVR were driven by lower risk for cardiac death or spontaneous target vessel-related MI.
Intravascular imaging-guided PCI showed benefit vs. angiography for patients with left main CAD, with significantly lower risk for cardiac death or spontaneous target vessel-related MI, researchers reported.
“Unprotected left main coronary artery (LMCA) disease, observed in 5% to 7% of patients undergoing coronary angiography, is a condition known for its higher mortality and morbidity. ... In the current era, PCI has been a feasible alternative to coronary bypass surgery for treatment of LMCA disease,” Woochan Kwon, MD, of the Samsung Medical Center and the Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “We performed a prespecified substudy investigating whether the benefit of intravascular imaging would be maintained for patients with LMCA disease who were included in the RENOVATE-COMPLEX-PCI.”
Image: Adobe Stock
The RENOVATE-COMPLEX-PCI trial
RENOVATE-COMPLEX-PCI was a prospective, randomized, open-label, multicenter trial designed to evaluate whether intravascular imaging-guided PCI (Opticross, Boston Scientific; Dragonfly, Abbott Vascular) could reduce target vessel failure compared with angiography-guided PCI among 1,639 patients with complex coronary artery lesions (mean age, 66 years; 79% men). The primary endpoint was a composite of TVF, defined as cardiac death, target vessel-related MI and target vessel revascularization.
As Healio previously reported, results of the RENOVATE-COMPLEX-PCI trial supported the use of an intravascular imaging-guided approach to PCI for complex coronary artery lesions, which was associated with lower risk for TVF compared with angiography-guided PCI at 3 years.
For the present study, Kwon and colleagues evaluated whether the prognostic benefits of intravascular imaging-guided PCI extended to a subgroup of 192 trial participants who underwent PCI for left main CAD.
This post hoc analysis of the RENOVATE-COMPLEX-PCI trial was published in Circulation: Cardiovascular Interventions.
Within this cohort, 138 participants underwent intravascular imaging-guided PCI and 54 underwent angiography-guided PCI. Procedures for the intravascular imaging group included either IVUS or OCT; modality was chosen at the operator’s discretion.
During a median follow-up of 2.1 years, intravascular imaging-guided PCI was associated with lower incidence and risk for TVF compared with angiography-guided PCI (6.8% vs. 25.1%; HR = 0.31; 95% CI, 0.13-0.76; P = .01), a finding primarily driven by lower risk for cardiac death or spontaneous target vessel-related MI (1.6% vs. 12.7%; HR = 0.16; 95% CI, 0.03-0.82; P = .028).
The association between intravascular imaging–guided PCI and lower risk for TVF remained significant after researchers adjusted for various clinical factors (HR = 0.29; 95% CI, 0.12-0.72; P = .007), according to the study.
“Intravascular imaging-guided PCI for left main coronary artery disease showed significantly lower risk of a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization than the angiography-guided PCI group,” the researchers wrote. “These results imply that benefits of intravascular imaging are sustained in left main coronary artery PCI. Further study is warranted to confirm the current results.”
Imaging guidance should be ‘requirement’ for left main PCI
In a related editorial, Debabrata Mukherjee, MD, MS, professor and chair of the department of internal medicine at Texas Tech University Health Sciences Center, discussed how the findings could inform future clinical guidelines.
“Imaging guidance for left main PCI is currently a class IIa recommendation in the 2021 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions revascularization guidelines,” Mukherjee wrote. “Given that several trials have now shown substantial improvement in PCI outcomes with imaging guidance compared with standard angiographic guidance, it is definitive that imaging guidance provides substantial benefit for patients undergoing complex PCI, especially left main PCI, suggesting that an upgrade to a level 1 recommendation based on the totality of evidence is now appropriate.
“Imaging guidance for left main PCI should no longer be an option but a requirement for providing the best possible revascularization outcome for these high-risk patients,” he wrote.
Reference:
Collapse
Click Here to Manage Email Alerts