Using endovascular images to guide stent implantation during percutaneous coronary intervention (PCI) in patients with heart disease improves survival compared to angiography-guided PCI alone, the most commonly used method. rates and reduce adverse cardiovascular events.

These are the largest and most comprehensive clinical studies of their kind, comparing two types of intravascular imaging modalities (intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) with angiography-guided PCI. These are the results of the study. The study was published on Wednesday, February 21st. lancet, We show for the first time that these two high-resolution imaging methods can reduce all-cause mortality, heart attacks, stent thrombosis, and the need for revascularization.

Synthesizing all early and recent clinical studies, our study shows that the routine use of intravascular image guidance improves survival and improves the safety of modern coronary stenting with superior drug elution. For the first time, we show that all aspects of performance and effectiveness are enhanced. stent. ”

Greg W. Stone, MD, first author

Dr. Stone is Dean of Academic Affairs at the Mount Sinai Health System and Professor of Medicine (Cardiology) and Population Health Sciences and Policy at the Icahn School of Medicine at Mount Sinai.

“Previous studies have shown the benefits of intravascular imaging, but never to this extent,” Dr. Stone added. “The addition of four recent trials enrolling 7,224 patients shows that intravascular imaging reduces all-cause death and heart attacks in a wide range of patients treated with stents. The routine use of intravascular imaging to guide stent implantation is one of the most effective treatments we have to improve outcomes for patients with coronary artery disease.”

In patients with coronary artery disease, plaque builds up in the arteries, causing chest pain, shortness of breath, and heart attacks. Many people undergo PCI. PCI is a nonsurgical procedure in which an interventional cardiologist uses a catheter to place a stent in a blocked coronary artery. Restores blood flow to the arteries. Interventional cardiologists most commonly use angiography to guide PCI. This involves using a special dye (contrast agent) and her x-rays to see how blood flows through the heart’s arteries and highlight any blockages.

However, angiography has limitations, making it difficult to determine the actual arterial size and plaque composition, determining whether a stent is fully expanded after PCI, and determining whether early and late angiography It is not ideal for detecting other conditions that affect the results. procedure. Intravascular ultrasound was introduced more than 30 years ago to provide more accurate and specific images of the coronary arteries. Although studies have shown that IVUS-guided PCI is superior to angiography-guided PCI and reduces cardiovascular events, it can be difficult to interpret images; It is only used in about 15-20% of PCI cases. The procedure is not fully refundable.

Optical coherence tomography uses light instead of sound to create images of occlusions. OCT images have much higher resolution than IVUS, making them more accurate and detailed, making them easier to interpret. However, OCT, a new technology, is used in only 3% of PCI cases, due in part to a lack of research data, and this new study addresses its limitations.

In this study, researchers looked at data from 15,964 patients who underwent PCI in 22 trials conducted from March 2010 to August 2023 at hundreds of centers across the United States, Europe, Asia, and beyond. was analyzed. Patients underwent either angiography-guided PCI or endovascular image-guided PCI. PCI using IVUS or OCT. During follow-up of 6 to 60 months, with an average of 2 years, patients who received endovascular imaging guidance had a 25% reduction in all-cause mortality, a 45% reduction in cardiac death, and a 17% reduction in all myocardial infarctions. Compared to angiographic guidance, stent thrombosis is reduced by 48%. The study also found that intravascular imaging reduced target vessel myocardial infarction by 18 percent and target lesion revascularization by 28 percent. Results were similar for OCT-guided and IVUS-guided PCI.

“Given these results, we are now taking steps to improve the routine use of OCT and IVUS, from conducting further research to determine whether intravascular imaging is beneficial, to improving physician and staff training and increasing reimbursement. We need to shift to intensifying efforts to overcome remaining barriers to use,” Dr. Stone said. “In this regard, we now have evidence that endovascular imaging guidance for PCI surgery has a greater impact on improving patient lives than other routine treatments that are more widely used and reimbursed. We now have better “hard evidence.”