With the rapid development of interventional diagnosis and treatment of coronary heart disease, coronary angiography has been far from meeting the current demand for accurate diagnosis and treatment. Intravascular imaging (such as IVUS and OCT) has gradually become an important method to help doctors complete accurate interventional diagnosis and treatment. At this conference, Professor Jou-Yong Hahn from Samsung Medical Center in Seoul, South Korea was invited by this journal to conduct in-depth discussion on relevant issues combined with his latest research.
International Circulation: Would you please introduce us what are the advantages of Intravascular imaging in guiding coronary intervention compared with coronary angiography ?
Professor Joo-Yong Hahn: Intravascular imaging can provide useful information on lesion assessment with regard to severity and morphology. Intravascular imaging also provides information for selection of stent size and length, and landing zone.
International Circulation: What is the current status of clinical application of IVUS and OCT? What are the requirements in the selection of patients and lesions?
Professor Joo-Yong Hahn: IVUS and OCT are complementary. The choice of the appropriate intravascular imaging modality differs according to the patient and diseased artery characteristics. For example, in patients with renal dysfunction, we have to use IVUS. In terms of the lesion characteristics, IVUS is preferable for left main lesions. But OCT has some advantages, such as in lumen assessment and stent-related morphology, and bifurcations.
International Circulation: Based on relevant studies, can intra-coronary imaging improve the clinical outcome of patients after PCI?
Professor Joo-Yong Hahn: I believe intracoronary imaging can improve clinical outcomes compared to angiography alone. That is why we conducted the RENOVATE-COMPLEX-PCI trial. In this trial, we compared intravascular imaging-guided PCI with angiography-guided PCI in patients with complex coronary artery lesions. We enrolled a total of 1639 patients, with 1092 assigned to the intravascular imaging-guided PCI group, and 547 assigned to the angiography-guided PCI group. At three years, the incidence of target vessel failure as the primary end point was 12.3% for the angiography-guided group, and 7.7% in the intravascular imaging-guided PCI group. The difference was statistically significant. The secondary endpoints - target-vessel failure without procedure-related MI, and a composite of cardiac death or target vessel-related MI, occurred less frequently in the intravascular imaging-guided PCI group, compared with the angiography-guided PCI group. However, the incidence of target lesion revascularization (TLR) and target vessel revascularization (TVR) were not significantly different between the two groups. In summary, patients with complex coronary artery lesions treated with intravascular imaging-guided PCI were at reduced risk of target vessel failure compared to angiography-guided PCI. The results of our trial supports the concept that intravascular-imaging guided PCI shows a benefit in treating complex coronary artery disease.
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