Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Left Main Coronary Artery Disease: The OPTIVUS-Complex PCI Study LMCA Cohort.

Abstract

The impact of optimal intravascular ultrasound (IVUS)-guided left main coronary artery (LMCA) percutaneous coronary intervention (PCI) on clinical outcomes has not been adequately evaluated yet. The OPTIVUS-Complex PCI study LMCA cohort was a prospective multicenter single-arm trial enrolling 902 patients undergoing LMCA PCI targeting the prespecified IVUS criteria (minimal stent area ≥5.0 mm² for left circumflex artery ostium, ≥6 mm² for left anterior descending coronary artery ostium, ≥7 mm² for polygon of confluence, and ≥8.0 mm² for proximal LMCA). The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. The predefined performance goals were based on the CREDO-Kyoto PCI/coronary artery bypass grafting (CABG) registry cohort-2 (PCI: 32.0%, and CABG: 13.9%). The OPTIVUS criteria were met in 73.7% of patients. The prevalence of true bifurcation LMCA lesion was 18.4%. The cumulative 1-year incidence of the primary endpoint was 13.2% (95%CI: 11.0-15.4%), which was significantly lower than the PCI performance goal (32.0%, P<0.0001), and numerically lower than the CABG performance goal (13.9%). The cumulative 1-year incidences of target-lesion revascularization and target-lesion revascularization for LMCA lesions were 4.2% and 3.0%. The cumulative 1-year incidence of the primary endpoint was not different regardless of meeting or not meeting the OPTIVUS criteria (13.4% versus 14.2%, log-rank P=0.79), while those of target-lesion revascularization and target-lesion revascularization for LMCA lesions were significantly lower in patients meeting the OPTIVUS criteria than in patients not meeting the OPTIVUS criteria (3.3% versus 7.7%, log-rank P=0.01, and 2.3% versus 5.5%, log-rank P=0.02). In conclusion, IVUS-guided LMCA PCI targeting the OPTIVUS criteria in the contemporary clinical practice was associated with a significantly lower rate of cardiovascular event than the predefined PCI performance goal, and with a numerically lower rate of cardiovascular event than the predefined CABG performance goal at 1 year.