Advantage of intravascular imaging consistent
Of the complex lesions, most (55%) had diffuse long coronary artery lesions, but other types of complex PCI, including bifurcated lesions (22%), chronic total occlusions (20%), severely calcified lesions (14%), and ostial lesions of a major coronary artery (15%) were represented. Across these lesion types, intravascular imaging was favored over angiography for TLF at least numerically. The potential exceptions were lesions requiring at least three stents (HR, 1.24; 95% CI, 0.49-3.18), but confidence intervals were wide.
The trial was unblinded, but Dr. Hahn reported that imaging analyses were performed at a core laboratory and events were adjudicated by a committee with members unaware of trial group assignments.
One unanswered question is cost. Because intravascular imaging adds cost to PCI relative to angiography, cost-effectiveness analyses are needed to provide context for the decision to use this approach in all complex PCI patients. These analyses are planned.
Based on the consistency of these trial results with previous studies, almost all of which showed the same thing, “the intravascular imaging world has spoken,” said Wayne B. Batchelor, MD, director of interventional cardiology, Inova Heart and Vascular Institute, Fairfax, Va. “The only question now is when will the interventional community is going to listen.”
Ted Bosworth/MDedge News
Dr. Wayne B. Batchelor
Dr. Batchelor predicted that these data will change the mindset of many practitioners “to shift the debate to why not do it [intravascular imaging] from why do it.”
“Only about 15% of PCI is performed with intravascular imaging in the United States, and these [results] argue that this number needs to go up,” Dr. Batchelor said. Although he said there are technical reasons, such as diffuse lesions or small vessels, that prevent intravascular imaging from being used in every complex patient, he suggested the data are compelling.
“If you apply this to the one million patients undergoing PCI in the United States, this will translate potentially into tens of thousands of patients protected from the TVF endpoint,” Dr. Batchelor said.
Dr. Hahn reports no potential conflicts of interest, but this investigator-initiated trial received funding from Boston Scientific and Abbott Vascular. Dr. Batchelor reports financial relationships with Abbott Vascular, Boston Scientific, Idorsia, Medtronic, and V-Wave Medical.