New follow-up data from the RENOVATE-COMPLEX-PCI trial suggests that intravascular imaging continues to provide better clinical outcomes for patients with complex coronary lesions five years after their PCI procedure.
- Intravascular imaging (IVI) refers to catheter-based invasive technologies used to visualize the inside of coronary arteries in real-time.
- The two IVI modalities are intravascular ultrasound and optical coherence tomography, providing cross-sectional images of the vessel wall to guide stent placement.
The RENOVATE-COMPLEX-PCI trial originally randomized 1.6k patients with complex coronary lesions to receive either IVI or angiography guided PCI and found that IVI led to a 36% relative reduction in composite target lesion failure (TLF) compared to angiography after a two year follow-up.
- More specifically, target-vessel MI or cardiac death was reduced by 37%, and cardiac death alone decreased by 53%.
For this latest analysis, researchers followed up after five years and found that…
- The primary TLF endpoint was still significantly lower when intravascular imaging was used to guide PCI (10.5% vs. 14.9%).
- Meanwhile, the composite of cardiac death or target-vessel MI occurred in 7.6% of the imaging group and 10.7% of the angiography group.
Landmark analysis of the data also revealed that most of IVI’s advantages occurred within the first two years following PCI, with no significant difference between the two groups in the years after.
However, due to cost and education, IVI has yet to be widely adopted in the United States despite guidelines giving the methodology a class 1A indication for guiding PCI in chronic and acute coronary syndromes.
- For example, the median cost of hospitalization for single-vessel PCI using IVUS or OCT was approximately $23k from 2016-2018, compared to $19k without these imaging technologies.
- That said, RENOVATE-COMPLEX-PCI’s evidence stands out, since prior studies of IVI PCI did not always show significant decreases in mortality and target vessel MI.
The Takeaway
While the initial two year results of RENOVATE-COMPLEX-PCI were strong, the five year results now provide a robust argument for making intravascular imaging the go-to when it comes to PCI guidance. The even better news is that outcomes like these may be enough to overcome the initial cost of implementing IVI.
