Intravascular Imaging–Guided or Angiography-Guided Complex PCI

doi:10.1056/nejmoa2216607

Randomised controlled trial

Intravascular Imaging–Guided or Angiography-Guided Complex percutaneous coronary intervention (PCI)

N Engl J MedPublished 5 Mar 2023

Randomised controlled trial
prospective
multicentre
open-label
2:1 randomisation

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Authors' conclusion

Among patients with complex coronary-artery lesions, intravascular imaging-guided PCI led to a lower risk of a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization than angiography-guided PCI.

Study context

Population: Patients with complex coronary-artery lesions in South Korea
Participants: 1,639 patients

Comparison: Intravascular imaging-guided PCI vs angiography-guided PCI
Intravascular imagingn = 1,092
Angiographyn = 547reference
Primary endpoint: Cardiac death, target-vessel MI or clinically driven target-vessel revascularization
Follow-up: Median 2.1 years (IQR 1.4 to 3.0)

Primary result

As reported in the abstract

Hazard ratio

0.64

95% CI 0.45–0.89

P = 0.008

Events by treatment group

Intravascular imaging7.7%76 of 1092

Angiography12.3%60 of 547

Intravascular imaging vs Angiography

HR 0.64 (95% CI 0.45–0.89); P = 0.008

Further findings

Cardiac death

Intravascular imaging1.7%

Angiography3.8%

Target-vessel MI

Intravascular imaging3.7%

Angiography5.6%

Clinically driven target-vessel revascularization

Intravascular imaging3.4%

Angiography5.5%

Safety

Procedure-related safety events

No apparent between-group differences

Original publication

Intravascular Imaging–Guided or Angiography-Guided Complex PCI. N Engl J Med. Published 5 March 2023. doi:10.1056/nejmoa2216607

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Summarised from the published abstract; every number is checked against it