This study investigated the clinical outcomes of intravascular imaging-guided percutaneous coronary intervention (PCI) for complex coronary-artery lesions compared to angiography-guided PCI. The study was a prospective, multicenter, open-label trial in South Korea, and 1639 patients were randomly assigned 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 of the study was a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization. Safety was also assessed. At a median follow-up of 2.1 years, a primary end-point event had occurred in 76 patients (7.7%) in the intravascular imaging group and 60 patients (12.3%) in the angiography group, indicating a lower risk of primary end-point events in the intravascular imaging group (hazard ratio, 0.64; 95% confidence interval, 0.45 to 0.89; P=0.008).
Death from cardiac causes occurred in 16 patients (1.7%) in the intravascular imaging group and 17 patients (3.8%) in the angiography group, target-vessel-related myocardial infarction occurred in 38 (3.7%) and 30 (5.6%), respectively, and clinically driven target-vessel revascularization in 32 (3.4%) and 25 (5.5%), respectively. There were no significant differences in the incidence of procedure-related safety events between the two groups.
In conclusion, intravascular imaging-guided PCI resulted in a lower risk of a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization compared to angiography-guided PCI among patients with complex coronary-artery lesions.
DOI: 10.1056/NEJMoa2216607
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