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- Title
Intravascular Imaging in Patients With Complex Coronary Lesions and Chronic Kidney Disease.
- Authors
Kwon, Woochan; Choi, Ki Hong; Song, Young Bin; Park, Yong Hwan; Lee, Joo Myung; Lee, Jong-Young; Lee, Seung-Jae; Lee, Sang Yeub; Kim, Sang Min; Yun, Kyeong Ho; Cho, Jae Young; Kim, Chan Joon; Ahn, Hyo-Suk; Nam, Chang-Wook; Yoon, Hyuck-Jun; Lee, Wang Soo; Jeong, Jin-Ok; Song, Pil Sang; Doh, Joon-Hyung; Jo, Sang-Ho
- Abstract
This cohort study evaluates whether the outcomes of intravascular imaging–guided procedural optimization would be different according to the presence of chronic kidney disease. Key Points: Question: Is intravascular imaging beneficial in patients with complex coronary lesions and chronic kidney disease? Findings: In this prespecified cohort substudy of the RENOVATE-COMPLEX-PCI trial with 1639 patients with or without chronic kidney disease, intravascular imaging–guided revascularization was associated with significantly lower incidence of the target vessel failure (a composite of cardiac death, myocardial infarction, or target vessel revascularization) compared with angiography-guided revascularization, whether with chronic kidney disease or not. Meaning: These findings suggest that in patients with complex coronary artery lesions, intravascular imaging–guided revascularization was superior to angiography-guided revascularization in reducing the risk of target vessel failure, regardless of kidney function. Importance: As patients with chronic kidney disease (CKD) are more likely to have complex coronary lesions, intravascular imaging guidance in percutaneous coronary intervention (PCI) for this population could be potentially beneficial. Objectives: To investigate whether the outcomes of intravascular imaging–guided procedural optimization would be different according to the presence of CKD. Design, Setting, and Participants: This was a prespecified substudy of RENOVATE-COMPLEX-PCI, a recently published multicenter randomized clinical trial in Korea studying the benefits of intravascular imaging for complex coronary lesions. Patients with complex coronary lesions, with or without CKD, were enrolled between May 2018 and May 2021. Data were analyzed from January to June 2023. Interventions: PCI in each group was done either under the guidance of intravascular imaging or angiography alone. Main Outcomes and Measures: The primary end point was target vessel failure (TVF) at the 3-year point, defined as a composite of cardiac death, target vessel–related myocardial infarction, or clinically driven target vessel revascularization. Results: A total of 1639 patients (1300 male [79.3%]) treated with PCI for complex coronary lesions were stratified into CKD (296 participants) and non-CKD (1343 participants) groups. The mean (SD) age of each group was 70.3 (9.4) and 64.5 (10.1) years, and mean (SD) estimated serum creatinine was 2.9 (5.3) and 0.8 (0.2) mg/dL for CKD and non-CKD groups, respectively. Intravascular imaging–guided revascularization was associated with significantly lower incidence of the primary end point compared with angiography-guided revascularization in both CKD (13.3% vs 23.3%; hazard ratio [HR], 0.51; 95% CI, 0.27-0.93; P =.03) and non-CKD (6.4% vs 9.9%; HR, 0.66; 95% CI, 0.44-0.99; P =.05) groups. The significantly lower incidence of the primary end point was mainly associated with the lower risk of cardiac death or target vessel–related myocardial infarction (9.4% vs 22.2%; HR, 0.39; 95% CI, 0.20-0.76; P =.006) in the CKD group and by target vessel revascularization (3.0% vs 5.5%; HR, 0.55; 95% CI, 0.30-0.99; P =.05) in the non-CKD group. Those with a glomerular filtration rate of at least 30 mL/min/1.73m2 and less than 60 ml/kg/1.73m2 showed the greatest benefit from imaging-guided complex PCI (8.8% vs 21.2%; HR, 0.28; 95% CI, 0.11-0.68; P =.02). Conclusions and Relevance: In this prespecified cohort substudy of the Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention trial, intravascular imaging guidance showed clinical benefit over angiography guidance in reducing the risk of TVF, regardless of the presence of CKD. The greatest benefits of imaging-guided complex PCI were observed in stage 3 CKD. Trial Registration: ClinicalTrials.gov Identifier: NCT03381872
- Subjects
KIDNEY disease diagnosis; CHRONIC disease diagnosis; GLOMERULAR filtration rate; PERCUTANEOUS coronary intervention; CONFIDENCE intervals; PSYCHOLOGY of cardiac patients; CORONARY disease; MYOCARDIAL infarction; CORONARY artery disease; DESCRIPTIVE statistics; RESEARCH funding; ODDS ratio
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2345554
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.45554