Intravascular Imaging-Guided PCI vs Coronary Artery Bypass Grafting for Left Main or 3-Vessel Disease

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-09-08 DOI:10.1016/j.jcin.2025.06.034

Sang Yoon Lee MD , Yang Hyun Cho MD, PhD , Kiick Sung MD, PhD , Wook Sung Kim MD, PhD , Seung-Jae Lee MD, PhD , Woochan Kwon MD , Jong-Young Lee MD, PhD , Seung Hun Lee MD, PhD , Doosup Shin MD , Sang Yeub Lee MD, PhD , Sang Min Kim MD, PhD , Kyeong Ho Yun MD, PhD , Jae Young Cho MD, PhD , Chan Joon Kim MD, PhD , Hyo-Suk Ahn MD, PhD , Chang-Wook Nam MD, PhD , Hyuck-Jun Yoon MD, PhD , Yong Hwan Park MD, PhD , Wang Soo Lee MD, PhD , Ki Hong Choi MD, PhD , Joo Myung Lee MD, MPH, PhD

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引用次数: 0

Abstract

Background

Previous trials have shown that coronary artery bypass graft (CABG) has better clinical outcomes compared with percutaneous coronary intervention (PCI) for patients with left main coronary artery or 3-vessel disease. However, it is unclear whether intravascular imaging (IVI)-guided PCI would reduce the difference in clinical events compared to CABG.

Objectives

The present study sought to compare the clinical outcomes of patients with left main or 3-vessel disease who underwent IVI-guided PCI with those who underwent CABG.

Methods

A total of 6,962 patients with left main or 3-vessel disease from the RENOVATE-COMPLEX-PCI trial (n = 1,639) and the institutional registry of Samsung Medical Center (2,972 patients underwent PCI and 6,600 patients underwent CABG) were analyzed. The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or stroke at 3 years.

Results

Among the study population, 848 patients underwent IVI-guided PCI, 987 patients underwent angiography-guided PCI, and 5,127 patients underwent CABG. Patients treated with PCI had significantly higher risk of primary outcome than patients who underwent CABG (13.3% vs 10.8%; HR: 1.23; 95% CI: 1.05-1.44; P = 0.013). However, the risk of primary outcome was comparable between IVI-guided PCI and CABG (8.7% vs 10.8%; HR: 0.77; 95% CI: 0.59-1.01; P = 0.058). The propensity score–matched analysis showed similar results between IVI-guided PCI and CABG (9.5% vs 9.4%; HR: 0.98; 95% CI: 0.69-1.40; P = 0.914).

Conclusions

In this hypothesis-generating study, PCI had significantly higher risk of a composite of death, nonfatal myocardial infarction, or stroke than CABG. However, IVI-guided PCI had comparable risk of clinical events compared with CABG. (Intravascular Imaging- Versus Angiography-Guided Percutaneous Coronary Intervention For Complex Coronary Artery Disease [RENOVATE-COMPLEX-PCI], NCT03381872; Institutional cardiovascular catheterization database of Samsung Medical Center (Long-Term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI, NCT03870815; Institutional coronary artery bypass grafting database of Samsung Medical Center (Long-Term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI, NCT03870815)

查看原文本刊更多论文

血管内成像引导下PCI与冠状动脉旁路移植术治疗左主干或三支血管疾病

先前的试验表明，对于左主干或三支血管疾病的患者，冠状动脉旁路移植术（CABG）比经皮冠状动脉介入治疗（PCI）具有更好的临床效果。然而，与CABG相比，血管内成像（IVI）引导的PCI是否会减少临床事件的差异尚不清楚。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.