Coronary disease & ACS

Intravascular Imaging- vs Angiography-Guided Complex Percutaneous Coronary Intervention (PCI): 5-Year Outcomes From a Randomized Trial

J Am Coll CardiolPublished Randomised controlled trial

Primary resultResult — go to the resultHazard ratio 0.68 95% CI 0.51–0.91

Authors' conclusion

In patients with complex coronary artery lesions undergoing PCI, intravascular imaging guidance reduced the risk of a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization at median follow-up of 5.3 years, compared to angiography guidance.

Study context

Population
Patients with complex coronary artery lesions, South Korea
Participants
1,639 patients
Comparison
Intravascular imaging-guided PCI vs angiography-guided PCI
  • Imaging-guided PCIn = 1,092
  • Angiography-guided PCIn = 547reference
Primary endpoint
Cardiac death, target vessel-related MI or clinically driven target vessel revascularization
Follow-up
Median 5.3 years (Q1-Q3: 4.4-6.2 years)
Methodological detailsprospective, multicentre, open-label, superiority, 2:1 randomisation
  • Prospective
  • Multicentre
  • Open-label
  • Superiority
  • 2:1 randomisation

Primary result

As reported in the abstract

median 5.3 years

Hazard ratio

0.68

95% CI 0.51–0.91

P = 0.009

Events by treatment group

Imaging-guided PCI vs Angiography-guided PCI
HR 0.68 (95% CI 0.51–0.91); P = 0.009

Further findings

Cardiac death or target vessel-related MI

Clinically driven target vessel revascularization

Safety

Definite stent thrombosis

Procedure-related safety events

No apparent differences between the groups

Original publication

Intravascular Imaging- vs Angiography-Guided Complex PCI: 5-Year Outcomes From a Randomized Trial. J Am Coll Cardiol. Published 4 March 2026. doi:10.1016/j.jacc.2026.01.035

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

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