Key result
Intravascular imaging-guided PCI improves clinical outcomes over angiography guidance despite low real-world adoption.
Why the study?
Despite clinical benefits over angiography guidance, real-world intravascular imaging use remains low, randomized data comparing OCT-guided PCI to angiography guidance are scarce, and trials comparing PCI to CABG rarely incorporated imaging.
Does intravascular imaging-guided percutaneous coronary intervention improve clinical outcomes compared to angiography-guided PCI?
Does intravascular imaging-guided percutaneous coronary intervention improve clinical outcomes compared to angiography-guided PCI?
Intravascular imaging-guided PCI improves clinical outcomes compared to angiography-guided PCI, but optimal stent expansion criteria and comparisons with CABG require further investigation.
Supports imaging-guided PCI consideration; leaves open optimal criteria and CABG comparisons.
Intravascular imaging-guided percutaneous coronary intervention (PCI) may provide a more accurate assessment of the lumen and vessel dimensions and plaque characteristics than angiography-guided PCI and facilitate optimal coronary stent implantation. Several randomized controlled trials have demonstrated that intravascular ultrasound (IVUS)-guided PCI improved clinical outcomes compared to angiography-guided PCI, although randomized data comparing optical coherence tomography (OCT)-guided PCI to angiography-guided PCI are scarce. One randomized controlled trial suggested that OCT-guided PCI was noninferior to IVUS-guided PCI. The advantages of OCT over IVUS include a better resolution, leading to easier interpretation of the images, while the disadvantages of OCT compared to IVUS include the need for flushing to clear the blood in the lumen, difficulty evaluating severe stenosis or ostial lesions, and increased contrast volume. Despite the reported clinical benefits of intravascular imaging-guided PCI over angiography-guided PCI, the prevalence of IVUS use in US and European real clinical practice is still low and has only slightly increased over time. In addition, intravascular imaging was only rarely used in previous landmark trials comparing PCI vs. coronary artery bypass grafting (CABG), and there are no data comparing intravascular imaging-guided PCI to CABG. This review has gathered evidence concerning the efficacy of intravascular imaging-guided PCI and future perspectives on intravascular imaging-guided PCI.
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Yamamoto et al. (2023) conducted a review in Coronary artery disease requiring PCI. Intravascular imaging-guided PCI vs. Angiography-guided PCI was evaluated. Intravascular imaging-guided PCI improves clinical outcomes compared to angiography-guided PCI, though its real-world adoption remains low and data comparing it to CABG are lacking.
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