The randomised RENOVATE-COMPLEX-PCI trial showed that percutaneous coronary intervention (PCI) guided by intravascular imaging for complex coronary artery lesions was associated with a lower risk of death than angiography-guided PCI.
RENOVATE-COMPLEX-PCI (NCT03381872) was an investigator-initiated, prospective, randomised, open-label trial at 20 sites in South Korea . The participants had coronary artery disease requiring PCI and had a complex coronary artery lesion. They were randomised 2:1 to undergo either intravascular imaging–guided PCI or angiography-guided PCI. For patients in the intravascular imaging group, the choice between intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) was made at the operators’ discretion. Intravascular imaging could be used at any time during the PCI procedure but was mandatory after stent implantation. The primary endpoint was a composite of death from cardiac causes, target vessel-related myocardial infarction (MI), or clinically-driven target vessel revascularisation (TVR).
The results after a median follow-up of 2.1 years were presented by Prof. Joo-Yong Hahn (Sungkyunkwan University School of Medicine, South Korea). Of the 5,586 assessed patients, 1,639 were randomised to intravascular imaging-guided PCI (n=1,092) or angiography-guided PCI (n=547). The median age was 66 years, and 21% of the participants were women. The primary endpoint was met by 7.7% of patients in the intravascular imaging group and by 12.3% in the angiography group (HR 0.64; 95% C 0.45–0.89; P=0.008): a statistically significant difference. Target vessel failure excluding procedural MI was seen in 8.7% and 5.1% of patients, respectively (HR 0.59; 95% CI 0.39–0.90; P=0.008).
Cardiac death occurred in 1.7% and 3.8% of participants in the intravascular imaging group and angiography group (HR 0.47; 95% CI 0.24–0.93), and target vessel-related MI in 3.7% and 5.6% (HR 0.74; 95% CI 0.45–1.22), respectively. The incidence of TVR was not significantly different: 3.4% and 5.5%, respectively (HR 0.69; 95% CI 0.40–1.18). Prof. Hahn added that in a prespecified subanalysis, between-group differences were consistent across various subgroups, including the type of imaging device, initial presentation, and diabetes. No differences were observed in the safety of both procedures.
Prof. Hahn concluded that “the results support the use of intravascular imaging-guided PCI in patients with complex coronary lesions.”
- Hahn J-Y, et al. Intravascular imaging-guided versus angiography-guided procedural optimization in complex percutaneous coronary intervention. Session 405-10, ACC Scientific Session 2023, 4–6 March, New Orleans, USA.
Copyright ©2023 Medicom Medical Publishers
« Selective JAK1/TYK2 inhibition: a novel way to overcome tofacitinib resistance in RA? Next Article
Immediate complete revascularisation non-inferior to staged complete revascularisation »
Table of Contents: ACC 2023
Letter from the Editor
ACC 2023 Highlights Podcast
Heart Failure and Cardiomyopathy
No need to restrict vigorous exercise in selected HCM patients?
No difference in CV outcomes between PET or CMR and SPECT
Interventional and Structural Cardiology
Benefits of MitraClip sustained to 5 years in COAPT trial
Transcatheter repair for patients with tricuspid regurgitation
Minimally invasive versus conventional sternotomy for mitral valve repair
Durable benefits of TAVR versus surgical aortic valve replacement in aortic stenosis patients
PCI not better than GDMT in severe ischaemic cardiomyopathy
Anticoagulation in non-critically ill hospitalised COVID patients
Statins associated with reduced heart dysfunction from anthracyclines
Multifaceted strategy improves prescription of therapies for diabetes and ASCVD
Bempedoic acid benefits statin-intolerant patients at high cardiovascular risk
Evolocumab improves coronary plaque morphology in stable CAD
Inflammation stronger predictor of MACE than cholesterol levels
Oral PCSK9 inhibitor significantly lowers LDL-C
Baxdrostat in patients with uncontrolled hypertension
Hormone therapy for gender dysphoria associated with increased CV risk
Pulsed-field ablation appears safe and effective for atrial fibrillation
Key correlates of incident dementia identified in the MESA study
Pulmonary Arterial Hypertension
Sotatercept improves exercise capacity in patients with PAH
Fixed-dose macitentan plus tadalafil superior to either agent alone in PAH
Immediate complete revascularisation non-inferior to staged complete revascularisation
RENOVATE-COMPLEX-PCI results support intravascular-guided PCI for complex lesions
Apixaban plus P2Y12 inhibitor likely best for AF after ACS or PCI
Medical therapy versus PCI for ischaemic cardiomyopathy