계명대학교 의학도서관 Repository

Intravascular Imaging-Guided or Angiography-Guided Complex PCI

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Author(s)
Joo Myung LeeKi Hong ChoiYoung Bin SongJong-Young LeeSeung-Jae LeeSang Yeub LeeSang Min KimKyeong Ho YunJae Young ChoChan Joon KimHyo-Suk AhnChang-Wook NamHyuck-Jun YoonYong Hwan ParkWang Soo LeeJin-Ok JeongPil Sang SongJoon-Hyung DohSang-Ho JoChang-Hwan YoonMin Gyu KangJin-Sin KohKwan Yong LeeYoung-Hyo LimYun-Hyeong ChoJin-Man ChoWoo Jin JangKook-Jin ChunDavid HongTaek Kyu ParkJeong Hoon YangSeung-Hyuk ChoiHyeon-Cheol GwonJoo-Yong Hahn
Keimyung Author(s)
Nam, Chang WookYoon, Hyuck Jun
Department
Dept. of Internal Medicine (내과학)
Journal Title
N Engl J Med
Issued Date
2023
Volume
388
Issue
18
Abstract
Background:
Data regarding clinical outcomes after intravascular imaging-guided percutaneous coronary intervention (PCI) for complex coronary-artery lesions, as compared with outcomes after angiography-guided PCI, are limited.

Methods:
In this prospective, multicenter, open-label trial in South Korea, we randomly assigned patients with complex coronary-artery lesions in a 2:1 ratio to undergo either intravascular imaging-guided PCI or angiography-guided PCI. In the intravascular imaging group, the choice between intravascular ultrasonography and optical coherence tomography was at the operators' discretion. The primary end point was a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization. Safety was also assessed.

Results:
A total of 1639 patients underwent randomization, with 1092 assigned to undergo intravascular imaging-guided PCI and 547 assigned to undergo angiography-guided PCI. At a median follow-up of 2.1 years (interquartile range, 1.4 to 3.0), a primary end-point event had occurred in 76 patients (cumulative incidence, 7.7%) in the intravascular imaging group and in 60 patients (cumulative incidence, 12.3%) in the angiography group (hazard ratio, 0.64; 95% confidence interval, 0.45 to 0.89; P = 0.008). Death from cardiac causes occurred in 16 patients (cumulative incidence, 1.7%) in the intravascular imaging group and in 17 patients (cumulative incidence, 3.8%) in the angiography group; target-vessel-related myocardial infarction occurred in 38 (cumulative incidence, 3.7%) and 30 (cumulative incidence, 5.6%), respectively; and clinically driven target-vessel revascularization in 32 (cumulative incidence, 3.4%) and 25 (cumulative incidence, 5.5%), respectively. There were no apparent between-group differences in the incidence of procedure-related safety events.

Conclusions:
Among patients with complex coronary-artery lesions, intravascular imaging-guided PCI led to a lower risk of a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization than angiography-guided PCI. (Supported by Abbott Vascular and Boston Scientific; RENOVATE-COMPLEX-PCI ClinicalTrials.gov number, NCT03381872).
Keimyung Author(s)(Kor)
남창욱
윤혁준
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1533-4406
Source
https://www.nejm.org/doi/10.1056/NEJMoa2216607?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
DOI
10.1056/NEJMoa2216607
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45010
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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