Sang Lee; Seung-Jae Lee; Woochan Kwon; Seung Lee; Doosup Shin; Sang Lee; Sang Kim; Kyeong Yun; Jae Cho; Chan Kim; Hyo-Suk Ahn; Chang-Wook Nam; Hyuck-Jun Yoon; Yong Park; Wang Lee; Ki Choi; Taek Park; Jeong Yang; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Young Song; Joo-Yong Hahn; Jong-Young Lee; Joo Lee; the investigators

doi:10.4244/EIJ-D-24-00755

Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity

Sang Yoon Lee¹, MD; Seung-Jae Lee², MD, PhD; Woochan Kwon², MD; Seung Hun Lee³, MD, PhD; Doosup Shin⁴, MD; Sang Yeub Lee⁵^,⁶, MD, PhD; Sang Min Kim⁵, MD, PhD; Kyeong Ho Yun⁷, MD, PhD; Jae Young Cho⁷, MD, PhD; Chan Joon Kim⁸, MD, PhD; Hyo-Suk Ahn⁸, MD, PhD; Chang-Wook Nam⁹, MD, PhD; Hyuck-Jun Yoon⁹, MD, PhD; Yong Hwan Park¹⁰, MD, PhD; Wang Soo Lee¹¹, MD, PhD; Ki Hong Choi¹, MD, PhD; Taek Kyu Park¹, MD, PhD; Jeong Hoon Yang¹, MD, PhD; Seung-Hyuk Choi¹, MD, PhD; Hyeon-Cheol Gwon¹, MD, PhD; Young Bin Song¹, MD, PhD; Joo-Yong Hahn¹, MD, PhD; Jong-Young Lee², MD, PhD; Joo Myung Lee¹, MD, MPH, PhD; the RENOVATE-COMPLEX-PCI investigators

Abstract

Background: Recent trials have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) improves clinical outcome, as compared to angiography-guided PCI, in complex coronary artery lesions. However, it is unclear whether this benefit is affected by overall lesion complexity in each patient.

Aims: The present study sought to investigate the impact of overall lesion complexity on the benefit of IVI-guided PCI.

Methods: A total of 4,611 patients with complex coronary artery lesions from the RENOVATE-COMPLEX-PCI trial (n=1,639) and the institutional registry of the Samsung Medical Center (n=2,972) were classified according to the number of complex lesion features found in each patient. The primary outcome was target vessel failure (TVF) at 3 years, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularisation.

Results: The cutoff value for the number of complex lesion features to predict TVF, determined using the maximally selected log-rank test, was 3. Patients with ≥3 complex lesion features had a higher risk of TVF than those with <3 complex lesion features (11.0% vs 7.2%, hazard ratio [HR] 1.59, 95% confidence interval [CI]: 1.28-1.96; p<0.001). IVI-guided PCI significantly reduced the risk of TVF compared with angiography-guided PCI in both groups (≥3 complex lesion features: 7.4% vs 14.4%, HR 0.49, 95% CI: 0.35-0.69; p<0.001; <3 complex lesion features: 5.7% vs 8.1%, HR 0.72, 95% CI: 0.53-0.98; p=0.039). The benefit of IVI-guided PCI tended to increase as the number of complex lesion features increased (absolute risk reduction for TVF: –0.012 vs –0.027 vs –0.055 vs –0.077, respectively, for 1 vs 2 vs 3 vs ≥4 complex lesion features; interaction p=0.048).

Conclusions: In patients with complex coronary artery lesions, IVI-guided PCI showed a lower risk of TVF across all degrees of lesion complexity. The prognostic benefit of IVI-guided PCI tended to increase as patients had more complex lesion features. (RENOVATE-COMPLEX-PCI [ClinicalTrials.gov: NCT03381872]; Institutional cardiovascular catheterisation database of the Samsung Medical Center [ClinicalTrials.gov: NCT03870815]).

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