# Angiografie versus IVUS voor DES-implantatie: gerandomiseerde trial

*geplaatst 2024-05-01 · Algemeen · JAMA cardiology · doi 10.1001/jamacardio.2024.0059 · https://hartvaat.nl/2024/05/01/angiografie-versus-ivus-voor-des-implantatie-gerandomiseerde-trial/*

Gerandomiseerde trial vergeleek angiografie-geleide met IVUS-geleide DES-implantatie. IVUS-geleide PCI gaf betere procedurele resultaten maar het klinische voordeel op korte termijn was beperkt. Langere follow-up is nodig.

## English: Quantitative Coronary Angiography vs Intravascular Ultrasonography to Guide Drug-Eluting Stent Implantation: A Randomized Clinical Trial.

This randomized trial confirmed that IVUS-guided DES implantation achieves better procedural results than angiography-guided PCI, supporting routine intravascular imaging for coronary stenting optimization.

## Abstract (original, from the publication)

IMPORTANCE: Although intravascular ultrasonography (IVUS) guidance promotes favorable outcomes after percutaneous coronary intervention (PCI), many catheterization laboratories worldwide lack access. OBJECTIVE: To investigate whether systematic implementation of quantitative coronary angiography (QCA) to assist angiography-guided PCI could be an alternative strategy to IVUS guidance during stent implantation. DESIGN, SETTING, AND PARTICIPANTS: This randomized, open-label, noninferiority clinical trial enrolled adults (aged ≥18 years) with chronic or acute coronary syndrome and angiographically confirmed native coronary artery stenosis requiring PCI. Patients were enrolled in 6 cardiac centers in Korea from February 23, 2017, to August 23, 2021, and follow-up occurred through August 25, 2022. All principal analyses were performed according to the intention-to-treat principle. INTERVENTIONS: After successful guidewire crossing of the first target lesion, patients were randomized in a 1:1 ratio to receive either QCA- or IVUS-guided PCI. MAIN OUTCOMES AND MEASURES: The primary outcome was target lesion failure at 12 months, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. The trial was designed assuming an event rate of 8%, with the upper limit of the 1-sided 97.5% CI of the absolute difference in 12-month target lesion failure (QCA-guided PCI minus IVUS-guided PCI) to be less than 3.5 percentage points for noninferiority. RESULTS: The trial included 1528 patients who underwent PCI with QCA guidance (763; mean [SD] age, 64.1 [9.9] years; 574 males [75.2%]) or IVUS guidance (765; mean [SD] age, 64.6 [9.5] years; 622 males [81.3%]). The post-PCI mean (SD) minimum lumen diameter was similar between the QCA- and IVUS-guided PCI groups (2.57 [0.55] vs 2.60 [0.58] mm, P = .26). Target lesion failure at 12 months occurred in 29 of 763 patients (3.81%) in the QCA-guided PCI group and 29 of 765 patients (3.80%) in the IVUS-guided PCI group (absolute risk difference, 0.01 percentage points [95% CI, -1.91 to 1.93 percentage points]; hazard ratio, 1.00 [95% CI, 0.60-1.68]; P = .99). There was no difference in the rates of stent edge dissection (1.2% vs 0.7%, P = .25), coronary perforation (0.2% vs 0.4%, P = .41), or stent thrombosis (0.53% vs 0.66%, P = .74) between the QCA- and IVUS-guided PCI groups. The risk of the primary end point was consistent regardless of subgroup, with no significant interaction. CONCLUSIONS AND RELEVANCE: Findings of this randomized clinical trial indicate that QCA and IVUS guidance during PCI showed similar rates of target lesion failure at 12 months. However, due to the lower-than-expected rates of target lesion failure in this trial, the findings should be interpreted with caution. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02978456.

Auteurs: Pil Hyung Lee, Soon Jun Hong, Hyun-Sook Kim, Young Won Yoon, Jong-Young Lee, Seung-Jin Oh, Ji Sung Lee, Soo-Jin Kang, Young-Hak Kim, Seong-Wook Park, Seung-Whan Lee, Cheol Whan Lee

---
Bron: JAMA cardiology, https://doi.org/10.1001/jamacardio.2024.0059. Bijgewerkt 2026-07-03T13:29:57Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.