Coronary angiography matches IVUS in guiding PCI stent implantation

Intravascular ultrasound (IVUS) is on par with quantitative coronary angiography when it comes to guiding stent implantation, a study published March 13 in JAMA Cardiology found.

Researchers led by Cheol Whan Lee, MD, from the University of Ulsan in Seoul, South Korea, found that both methods during percutaneous coronary intervention (PCI) showed similar rates of target lesion failure at 12 months.

“Findings of this study suggest that a standardized quantitative coronary angiography-based PCI algorithm may be an acceptable alternative to IVUS-guided PCI, and warrants further research,” Lee and co-authors wrote.

While IVUS guidance improves outcomes after PCI, the researchers noted that “many” catheterization laboratories around the world do not have easy access to the modality. They added that reimbursement policies and excessive costs may be hindering IVUS’ use as a routine tool.

However, quantitative coronary angiography is “readily available” at catheterization laboratories, the research team highlighted. It added that this method also provides reliable and reproducible quantitative measures of coronary vessels.

Lee and colleagues studied whether systematic implementation of quantitative coronary angiography could be an alternative to IVUS in aiding angiography-guided PCI during stent implantation.

The study included 1,528 patients who underwent PCI, were enrolled in six cardiac centers from 2017 to 2021, and underwent follow-up through 2022. Of the total, 763 had quantitative coronary angiography guidance and 765 had IVUS guidance.

The post-PCI average minimum lumen diameter was similar between both PCI groups. This included a diameter of 2.57 mm for angiography guidance and 2.6 mm for IVUS guidance (p = 0.26).

Additionally, target lesion failure at 12 months occurred in 29 of 763 patients (3.81%) in the angiography-guided group and 29 of 765 patients (3.80%) in the IVUS-guided group (p = 0.99).

Finally, the team reported no difference in the rates of stent edge dissection (p = 0.25), coronary perforation (p = 0.41), or stent thrombosis (p = 0.74) between both PCI groups.

“The risk of the primary end point was consistent regardless of subgroup, with no significant interaction,” the study authors wrote.

Lee et al also pointed out that the overall event rates were “much lower than expected” among the participating patients who underwent stent implantation, writing that 8% was expected rather than under 4%. They suggested that because of this, the findings should be interpreted with caution.

Still, they highlighted that angiography showed comparable results compared with IVUS regarding the primary composite end point of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization at 12 months.

“Results were consistent between the intention-to-treat and per-protocol populations, and no safety concerns were raised for [angiography]-guided PCI,” the authors wrote.

The team called for future studies to be “meticulously designed” to further explore the potential role of quantitative coronary angiography-guided PCI.

The full study can be found here.

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