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Improved Clinical Outcomes with Intravascular Imaging-Guided PCI: Impact of Standardized Optimization Protocols

14 May 2024

Intravascular imaging (IVI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), play a crucial role in assessing lesion characteristics and optimizing stent placement during percutaneous coronary intervention (PCI). Studies have consistently shown that procedural optimization guided by IVUS leads to better clinical outcomes compared to angiography-guided PCI alone. Additionally, recent trials suggest similar outcomes between OCT-guided PCI and IVUS-guided PCI. The RENOVATE-COMPLEX-PCI trial demonstrated the superiority of IVI-guided PCI over angiography-guided PCI in patients undergoing complex procedures, showing significant reductions in cardiac death, target vessel-related myocardial infarction (MI), and target vessel revascularization. While previous studies have highlighted the benefits of intravascular imaging (IVI) in PCI, it remained uncertain whether contemporary practice changes, particularly the implementation of standardized optimization protocols, have resulted in improved clinical outcomes. In a recently published study, researchers examined whether the clinical outcomes of IVI-guided PCI differed before and after the adoption of standardized optimization protocols for IVI usage.

The study included 2,972 patients from an institutional registry (2008-2015, before standardized optimization protocols) and 1,639 patients from a recently published trial (2018-2021, after standardized optimization protocols). Patients were divided into two groups based on IVI usage. The primary outcome was 3-year target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization.

The IVI-guided PCI group demonstrated a significant reduction in TVF compared to the angiography-guided PCI group (10.0% vs 6.7%; HR: 0.77; 95% CI: 0.61-0.97; P = 0.027), primarily driven by decreased cardiac death or myocardial infarction in both past and present IVI-guided PCI groups. Moreover, when comparing past IVI and present IVI groups, TVF was significantly lower in the present IVI group (8.5% vs 5.1%; HR: 0.63; 95% CI: 0.42-0.94; P = 0.025), attributed to reduced target vessel revascularization in the present IVI group. These findings were consistent in the inverse-probability-weighting adjusted analysis.

The authors concluded that IVI-guided PCI yielded better clinical outcomes compared to angiography-guided PCI. Furthermore, the adoption of standardized optimization protocols for IVI usage further improved clinical outcomes following PCI.

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Original article: Kwon W et al. J Am Coll Cardiol Intv 2024;17:292–303. 

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