Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention
- Author(s)
- Woochan Kwon; Joo Myung Lee; Kyeong Ho Yun; Ki Hong Choi; Seung-Jae Lee; Jong-Young Lee; Sang Yeub Lee; Sang Min Kim; Jae Young Cho; Chan Joon Kim; Hyo-Suk Ahn; Chang-Wook Nam; Hyuck-Jun Yoon; Yong Hwan Park; Wang Soo Lee; Jin-Ok Jeong; Pil Sang Song; Joon-Hyung Doh; Sang-Ho Jo; Chang-Hwan Yoon; Min Gyu Kang; Jin-Sin Koh; Kwan Yong Lee; Young-Hyo Lim; Yun-Hyeong Cho; Jin-Man Cho; Woo Jin Jang; Kook-Jin Chun; David Hong; Taek Kyu Park; Jeong Hoon Yang; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Joo-Yong Hahn
- Keimyung Author(s)
- Nam, Chang Wook; Yoon, Hyuck Jun
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- Circ Cardiovasc Interv
- Issued Date
- 2023
- Volume
- 16
- Issue
- 12
- Keyword
- angiography; coronary artery; patients; percutaneous coronary intervention; prognosis
- Abstract
- Background:
The RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) demonstrated that intravascular imaging-guided percutaneous coronary intervention (PCI) improved clinical outcome compared with angiography-guided PCI for patients with complex coronary artery lesions. This study aims to assess whether the prognostic benefit of intravascular imaging-guided procedural optimization persists in patients undergoing PCI for left main coronary artery disease.
Methods:
Of 1639 patients enrolled in the RENOVATE-COMPLEX-PCI, 192 patients with left main coronary artery disease were selected for the current prespecified substudy. Selected patients were randomly assigned to either the intravascular imaging-guided PCI group (n=138) or the angiography-guided PCI group (n=54). The primary end point was target vessel failure defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.
Results:
At a median follow-up of 2.1 years (interquartile range 1.1 to 3.0 years), intravascular imaging-guided PCI was associated with lower incidence of primary end point compared with angiography-guided PCI (6.8% versus 25.1%; hazard ratio, 0.31 [95% CI, 0.13-0.76]; P=0.010). This significant reduction in primary end point was mainly driven by a lower risk of cardiac death or spontaneous target vessel-related myocardial infarction (1.6% versus 12.7%; hazard ratio, 0.16 [95% CI, 0.03-0.82]; P=0.028). Intravascular imaging-guided PCI was independently associated with a lower risk of primary end point, even after adjusting for various clinical factors (hazard ratio, 0.29 [95% CI, 0.12-0.72]; P=0.007).
Conclusions:
Intravascular imaging-guided PCI showed clinical benefit over angiography-guided PCI for left main coronary artery disease in reducing the risk of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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