Why is this study important?

• Despite an increasing body of evidence supporting its use to improve outcomes, utilization of intravascular imaging in PCI remains low.
• RENOVATE-COMPLEX-PCI trial demonstrated that in patients with complex coronary artery disease, intravascular imaging-guided PCI improves outcomes compared with angiography-guided PCI.

What question was this study supposed to answer?

Does the use of intravascular imaging improve intermediate-long term outcomes compared to angiography guided PCI in patients with complex coronary artery disease?

What did the study show?

At a median follow-up of 2.1 years, intravascular imaging–guided PCI for complex coronary artery lesions was associated with a lower incidence of a composite of death from cardiac causes, target-vessel related myocardial infarction or clinically driven target-vessel revascularization than angiography-guided PCI.

Complex coronary artery lesions were defined as an unprotected left main coronary artery disease; a severely calcified lesion, a lesion involving in-stent restenosis; a chronic total occlusion; true bifurcation lesions according to the Medina classification system with a side-branch diameter of at least 2.5 mm; long coronary-artery lesions that would involve an expected stent length of at least 38 mm; multivessel PCI involving at least two major epicardial coronary arteries being treated at the same time; a lesion that would necessitate the use of multiple stents (at least three planned stents); or ostial lesions of a major epicardial coronary artery.

Patients were randomly assigned in a 2:1 ratio to undergo either intravascular imaging–guided PCI or angiography-guided PCI after diagnostic coronary angiography.

Among the 1092 patients in the intravascular imaging group, 800 (73.3%) underwent imaging with the use of intravascular ultrasonography and 278 (25.5%) underwent imaging with the use of OCT. A primary end-point event occurred in 76 of 1092 patients in the intravascular imaging group and in 60 of 547 patients in the angiography group (7.7% vs. 12.3%). The risk of target-vessel failure without procedure related myocardial infarction was lower in the intravascular imaging group compared to the angiography group (5.1% vs. 8.7%). 

The trial results support the use of intravascular imaging–guided PCI for complex coronary artery lesions. 

All editors: Luai K. Tabaza, MD, FSCAI