Intravascular imaging-guided percutaneous coronary intervention (PCI) is associated with a lower rate of target lesion failure compared with angiography-guided PCI, according to late breaking research presented in a Hot Line session August 27 at ESC Congress 2023.
Intravascular imaging-guided percutaneous coronary intervention is associated with a lower rate of target lesion failure compared with angiography-guided PCI, according to late breaking research presented in a Hot Line session August 27 atNumerous randomized trials have compared intravascular imaging-guided PCI with angiography-guided PCI. However, most of these prior trials have used intravascular ultrasound .
The analysis incorporated 20 randomized trials of intravascular imaging-guided PCI compared with angiography-guided PCI in 12,428 patients with chronic and acute coronary syndromes. Of those, 7,038 were randomly allocated to intravascular imaging guidance , and 5,390 patients were randomly allocated to angiography guidance. Patients were followed for between six months and five years.
The primary endpoint was target lesion failure, defined as a composite of cardiac death, target vessel, or target lesion revascularization. Secondary endpoints included cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis, as well as all-cause death, all myocardial infarction and target vessel revascularization.
Intravascular imaging guidance of PCI resulted in reductions in the primary composite outcome of target lesion failure by 31% compared with angiography guidance of PCI. Regarding secondary outcomes, intravascular imaging guidance of PCI resulted in reductions in cardiac death by 46%, target vessel myocardial infarction by 20%, target lesion revascularization by 29%, and stent thrombosis by 52% compared with angiography guidance of PCI.
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