Intravascular Imaging–Guided or Angiography-Guided Complex PCI

Lee, Joo Myung; Choi, Ki Hong; Song, Young Bin; Lee, Jong‐Young; Lee, Seung-Jae; Lee, Sang Yeub; Kim, Sang Min; Yun, Kyeong Ho; Cho, Jae-Young; Kim, Chan Joon; Ahn, Hyo–Suk; Nam, Chang Wook; Yoon, Hyuck–Jun; Park, Yong Hwan; Lee, Wang Soo; Jeong, Jin‐Ok; Song, Pil Sang; Doh, Joon‐Hyung; Ho, Sang; Yoon, Chang‐Hwan; Kang, Min Gyu; Koh, Jin‐Sin; Lee, Kwan Yong; Lim, Young‐Hyo; Cho, Yun-Hyeong; Cho, Jin‐Man; Jang, Woo Jin; Chun, Kook Jin; Hong, Dongwan; Park, Taek Kyu; Yang, Jeong Hoon; Choi, Seung–Hyuk; Gwon, Hyeon‐Cheol; Hahn, Joo Yong

doi:10.1056/nejmoa2216607

Cited by 134 publications

(106 citation statements)

References 23 publications

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“…The remaining one trial combined both IVUS and OCT into one arm, so the results from its subgroup analysis comparing IVUS with CA, and OCT with CA were used. 35 A total of 12,895 patients were included, comprising of 5856, 1411, and 5628 patients who underwent IVUS‐guided, OCT‐guided, and CA‐guided PCI, respectively (Figure 2). Eighteen trials used DES while seven trials employed BMS (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography‐guided percutaneous coronary interventions: A systematic review, network meta‐analysis, and meta‐regression

Park

Jolly

et al. 2023

Cathet Cardio Intervent

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BackgroundIntracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on coronary angiography (CA) and have shown to improve clinical outcomes. We sought to compare the clinical efficacy of IVUS, OCT, and conventional CA‐guided percutaneous coronary interventions (PCI).MethodsFrequentist and Bayesian network meta‐analyses of randomized clinical trials were performed to compare clinical outcomes of PCI performed with IVUS, OCT, or CA alone.ResultsA total of 28 trials comprising 12,895 patients were included. IVUS when compared with CA alone was associated with a significantly reduced risk of major adverse cardiovascular events (MACE) (risk ratio: [RR] 0.74, 95% confidence interval: [CI] 0.63–0.88), cardiac death (RR: 0.64, 95% CI: 0.43–0.94), target lesion revascularization (RR: 0.68, 95% CI: 0.57–0.80), and target vessel revascularization (RR: 0.64, 95% CI: 0.50–0.81). No differences in comparative clinical efficacy were found between IVUS and OCT. Rank probability analysis bestowed the highest probability to IVUS in ranking as the best imaging modality for all studied outcomes except for all‐cause mortality.ConclusionCompared with CA, the use of IVUS in PCI guidance provides significant benefit in reducing MACE, cardiac death, and revascularization. OCT had similar outcomes to IVUS, but more dedicated studies are needed to confirm the superiority of OCT over CA.

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Section: Resultsmentioning

confidence: 99%

Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography‐guided percutaneous coronary interventions: A systematic review, network meta‐analysis, and meta‐regression

Park

Jolly

et al. 2023

Cathet Cardio Intervent

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“…Greater use may have improved outcomes after PCI, as a recent randomized trial in patients with complex coronary disease found that use of intravascular imaging results in lower rates of death, MI, or repeat revascularization compared with angiography guidance alone. 24 The difference in MI favoring CABG may have been lessened by the fact that more patients in the PCI arm were receiving dual antiplatelet therapy at 3 years (14% versus 5.3%); however, a recent study in patients with acute coronary syndrome found that prolonged dual antiplatelet treatment strategy after PCI did not lead to a reduction in MI compared with single antiplatelet therapy. 25 Longer follow-up is needed to assess the optimal strategy over the longer term, particularly because the difference in MI may continue to widen.…”

Section: Discussionmentioning

confidence: 99%

Fractional Flow Reserve–Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up of the FAME 3 Trial

Zimmermann,

Ding,

Pijls

et al. 2023

Circulation

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BACKGROUND: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI. METHODS: FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide. Patients were randomly assigned to receive FFR-guided PCI using zotarolimus drug-eluting stents or CABG. The prespecified key secondary end point of the trial reported here is the 3-year incidence of the composite of death, MI, or stroke. RESULTS: A total of 1500 patients were randomized to FFR-guided PCI or CABG. Follow-up was achieved in >96% of patients in both groups. There was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI compared with CABG (12.0% versus 9.2%; hazard ratio [HR], 1.3 [95% CI, 0.98–1.83]; P =0.07). The rates of death (4.1% versus 3.9%; HR, 1.0 [95% CI, 0.6–1.7]; P =0.88) and stroke (1.6% versus 2.0%; HR, 0.8 [95% CI, 0.4–1.7]; P =0.56) were not different. MI occurred more frequently after PCI (7.0% versus 4.2%; HR, 1.7 [95% CI, 1.1–2.7]; P =0.02). CONCLUSIONS: At 3-year follow-up, there was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI with current-generation drug-eluting stents compared with CABG. There was a higher incidence of MI after PCI compared with CABG, with no difference in death or stroke. These results provide contemporary data to allow improved shared decision-making between physicians and patients with 3-vessel coronary artery disease. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02100722.

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“…Furthermore, it could be that longer follow up duration than 1 year is required to detect differences in target vessel failure rates after intracoronary imaging use compared to angiographic‐guidance only. The RENOVATE‐COMPLEX PCI (Intravascular imaging vs. angiography‐guided PCI for complex coronary artery disease) trial included a larger population of patients with complex coronary lesions (1639 East Asian patients), with longer follow up and reported an overall lower incidence of target vessel failure at 3 years with IVUS or OCT use compared to angiographic‐guidance (7.7% vs. 12.3%; HR: 0.64 [95% CI: 0.45−0.89] p = 0.008) 24 . However, in the subset of patients who had PCI to bifurcation lesions ( n = 359), there was no difference in target vessel failure rates between the intravascular imaging group and angiography‐guidance group.…”

Section: Discussionmentioning

confidence: 99%

Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial

Maznyczka

Arunothayaraj²,

Egred

et al. 2023

Cathet Cardio Intervent

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BackgroundThe impact of intracoronary imaging on outcomes, after provisional versus dual‐stenting for bifurcation left main (LM) lesions, is unknown.ObjectivesWe investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study).MethodsFour hundred and sixty‐seven patients were randomized to dual‐stenting or a stepwise provisional strategy. Four hundred and fifty‐five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1‐year.ResultsIntracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic‐guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51−1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32−2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic‐guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04−4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22−1.46] p = 0.220).ConclusionsIn EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic‐guidance, outcomes were worse with a dual‐stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual‐stent than provisional strategy.

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Intravascular Imaging–Guided or Angiography-Guided Complex PCI

Cited by 134 publications

References 23 publications

Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography‐guided percutaneous coronary interventions: A systematic review, network meta‐analysis, and meta‐regression

Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography‐guided percutaneous coronary interventions: A systematic review, network meta‐analysis, and meta‐regression

Fractional Flow Reserve–Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up of the FAME 3 Trial

Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial

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