Intravascular imaging-guided PCI tied to fewer complications than angiography-guided PCI

Explaining the study background, they said there is a scarcity of data considering clinical outcomes after intravascular imaging–guided PCI for complex coronary-artery lesions compared to the outcomes after angiography-guided PCI.

To add more research and data to the aforementioned background, in this study, researchers assigned patients with complex coronary-artery lesions in a 2:1 ratio to undergo either intravascular imaging–guided PCI or angiography-guided PCI. The composite of death from cardiac causes, target-vessel–related myocardial infarction, or clinically driven target-vessel revascularization were the primary outcomes measured in the study.

The results of the study are:

• One thousand six hundred thirty-nine patients underwent randomization.
• The number of participants in intravascular imaging–guided PCI and angiography-guided PCI were 1092 and 547, respectively.
• At a median follow-up of 2.1 years, a primary end-point event occurred in 76 patients and 60 patients in the intravascular imaging and angiography groups, with a cumulative incidence of 7.7% and 12.3 %, respectively.
• In the intravascular imaging and angiography groups, 16 patients and 17 died due to cardiac causes, with a cumulative incidence of 1.7 % and 3.8 %, respectively.
• 30 and 38 patients had target-vessel–related myocardial infarction with a cumulative incidence of 3.7% and 5.6%, respectively.
• Thirty-two patients and 25 patients had clinically driven target-vessel revascularization with a cumulative incidence of 3.4% and 5.5% respectively.
• Researchers reported no apparent between-group differences in the incidence of procedure-related safety events.

Concluding further, they said among those with complex coronary-artery lesions, intravascular imaging–guided PCI has fewer complications like death due to cardiac causes, target-vessel–related myocardial infarction, or clinically driven target-vessel revascularization than angiography-guided PCI.

This research was supported by Abbott Vascular and Boston Scientific, as acknowledged.

Further reading:

https://www.nejm.org/doi/full/10.1056/NEJMoa2216607