A recent JACC: Cardiovascular Interventions analysis of 17 randomized trials suggests that intravascular cardiac imaging (intravascular ultrasound or optical coherence tomography) significantly reduces major cardiac events compared with angiography alone when guiding PCI with drug-eluting stents.
- Researchers already know that intravascular imaging–guided PCI reduces cardiovascular events compared with angiography.
- However, which modality is best is unclear since earlier intravascular imaging trials generally enrolled patients with mixed lesion types and lacked statistical power.
To help clarify intravascular imaging’s benefits, researchers synthesized data from 17 RCTs of drug-eluting stent PCIs for complex lesions, revealing consistent imaging benefits regardless of modality.
- OCT and IVUS guidance reduced MACE risk by 37% and 33% respectively versus angiography.
- Both showed significant MACE reduction across lesion types such as left main (IVUS RR: 0.52, OCT RR: 0.51), bifurcation (0.57, 0.70), calcification (0.61, 0.66), etc.
- For chronic total occlusions (CTOs), IVUS showed significant benefit (RR: 0.57) while OCT’s advantages weren’t statistically significant (RR: 0.61).
- Head-to-head comparisons between OCT and IVUS for each lesion type also showed no significant advantage for either modality.
Even with known technical differences between modalities like OCT’s superior spatial resolution versus IVUS’s greater tissue penetration depth, it’s clear that this study’s main message is that both of them are better than angiography to guide PCI, especially in complex lesions.
That said, researchers asserted that which modality should be used stems from procedural feasibility and imaging characteristics.
- For example, in chronic total occlusions, OCT is favored due to a lower risk of proximal cap puncture.
- Meanwhile in left main disease, IVUS is preferred due to superior tissue penetration in larger vessels.
- And it’s worth noting that for simple lesions, angiography is still a cost-effective and safe way to guide PCI.
The Takeaway
With so much data out there on imaging-guided-PCI, it can be hard to determine which modality is best, but the bottom line of this study is that both OCT and IVUS are a much better option than angiography when it comes to patients with complex lesions.
