Compared to angiography-guided PCI, imaging-guided complex PCI highly beneficial among patients with stage 3 CKD: JAMA

The prespecified cohort substudy of the RENOVATE-COMPLEX-PCI trial involving 1639 patients with or without chronic kidney disease (CKD) revealed that intravascular imaging–guided revascularization was linked to significantly lower incidence of the target vessel failure (a composite of myocardial infarction, cardiac death, and target vessel revascularization) compared with angiography-guided revascularization, whether with CKD or not.

As patients with CKD are more likely to have complex coronary lesions, intravascular imaging guidance in percutaneous coronary intervention (PCI) could be potentially beneficial for this population. Woochan Kwon, Sungkyunkwan University School of Medicine, Seoul, Korea, and colleagues aimed to investigate whether the outcomes of intravascular imaging–guided procedural optimization would be different according to the presence of CKD.

The researchers performed a prespecified substudy of RENOVATE-COMPLEX-PCI, a recently published multicenter RCT in Korea studying the benefits of intravascular imaging for complex coronary lesions.

The study enrolled 1639 patients (79.3% were males) with complex coronary lesions who were stratified into with CKD (296 participants) or without CKD (non-CKD; 1343 participants) groups. The mean age of each group was 70.3 and 64.5 years, and the mean estimated serum creatinine was 2.9 and 0.8 mg/dL for CKD and non-CKD groups, respectively.

In each group, PCI was done either with the guidance of intravascular imaging or angiography alone. The primary endpoint was target vessel failure (TVF) at the 3-year point.

The study revealed the following findings:

• Intravascular imaging–guided revascularization was associated with a significantly lower incidence of the primary endpoint compared with angiography-guided revascularization in both CKD (13.3% versus 23.3%; hazard ratio [HR], 0.51) and non-CKD (6.4% versus 9.9%; HR, 0.66) groups.
• The significantly lower incidence of the primary endpoint was mainly associated with the lower risk of cardiac death or target vessel–related myocardial infarction (9.4% versus 22.2%; HR, 0.39) in the CKD group and by target vessel revascularization (3.0% versus 5.5%; HR, 0.55) in the non-CKD group.
• Those with a glomerular filtration rate of at least 30 mL/min/1.73m2 and less than 60 ml/kg/1.73m2 showed the greatest benefit from imaging-guided complex PCI (8.8% vs 21.2%; HR, 0.28).

"The findings showed intravascular imaging–guided PCI to be superior to angiography-guided PCI in lowering the risk of target vessel failure in both non-CKD and the CKD population," the researchers wrote. "The benefit was more evident in the CKD population, specifically in those with stage 3 CKD."

Reference:

Kwon W, Choi KH, Song YB, et al. Intravascular Imaging in Patients With Complex Coronary Lesions and Chronic Kidney Disease. JAMA Netw Open. 2023;6(11):e2345554. doi:10.1001/jamanetworkopen.2023.45554