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<p>It remains unknown whether intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) can improve the clinical outcomes of complex PCI to a level equivalent to that of non-complex PCI. In the OPTIVUS-Complex PCI (Optimal Intravascular Ultrasound-Guided Complex PCI) Study multivessel cohort, a total of 1011 patients who underwent multivessel PCI involving a target lesion in the left anterior descending coronary artery (LAD) were divided into 2 groups: complex PCI (<i>N</i> = 760) and non-complex PCI groups (<i>N</i> = 251). Complex PCI was defined as a procedure with the following characteristics: 3 vessels treated, 3 stents implanted, 3 lesions treated, bifurcation with 2 stents implanted, total stent length &gt; 60&#xa0;mm, or target of chronic total occlusion. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) defined by a composite of death, myocardial infarction, stroke, or any coronary revascularization. The cumulative 1-year incidences of the primary endpoint and any coronary revascularization were not significantly different between the complex and non-complex PCI groups (10.9% vs. 8.3%, <i>P</i> = 0.24, and 7.7% vs. 4.8%, <i>P</i> = 0.12, respectively). In the multivariable Cox proportional hazards models, there was no significant excess risk of the complex PCI group relative to the non-complex PCI group for the primary endpoint (HR, 1.35; 95%CI, 0.83–2.18; <i>P</i> = 0.22), or for any coronary revascularization (HR, 1.64; 95%CI, 0.87–3.06; <i>P</i> = 0.11). After optimal IVUS-guided multivessel PCI with a target lesion in the LAD, 1-year risk of MACCE or coronary revascularization in patients with complex PCI was numerically higher than that in patients with non-complex PCI.</p> Graphical Abstract <p></p>

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Complex PCI and 1-year outcomes in the OPTIVUS-complex PCI study multivessel cohort

  • 期刊论文

  • 发表日期：

    2025年4月6日

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  • Masaomi Gohbara,
  • Kiyoshi Hibi,
  • Takeshi Morimoto,
  • Hidekuni Kirigaya,
  • Ko Yamamoto,
  • Koh Ono,
  • Hiroki Shiomi,
  • Masanobu Ohya,
  • Kyohei Yamaji,
  • Hiroki Watanabe,
  • Tetsuya Amano,
  • Yoshihiro Morino,
  • Kensuke Takagi,
  • Junko Honye,
  • Hitoshi Matsuo,
  • Mitsuru Abe,
  • Kazushige Kadota,
  • Kenji Ando,
  • Koichi Nakao,
  • Shinjo Sonoda,
  • Satoru Suwa,
  • Kazuya Kawai,
  • Ken Kozuma,
  • Yoshihisa Nakagawa,
  • Yuji Ikari,
  • Mamoru Nanasato,
  • Keiichi Hanaoka,
  • Kengo Tanabe,
  • Yoshiki Hata,
  • Takashi Akasaka,
  • Takeshi Kimura

摘要

It remains unknown whether intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) can improve the clinical outcomes of complex PCI to a level equivalent to that of non-complex PCI. In the OPTIVUS-Complex PCI (Optimal Intravascular Ultrasound-Guided Complex PCI) Study multivessel cohort, a total of 1011 patients who underwent multivessel PCI involving a target lesion in the left anterior descending coronary artery (LAD) were divided into 2 groups: complex PCI (N = 760) and non-complex PCI groups (N = 251). Complex PCI was defined as a procedure with the following characteristics: 3 vessels treated, 3 stents implanted, 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, or target of chronic total occlusion. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) defined by a composite of death, myocardial infarction, stroke, or any coronary revascularization. The cumulative 1-year incidences of the primary endpoint and any coronary revascularization were not significantly different between the complex and non-complex PCI groups (10.9% vs. 8.3%, P = 0.24, and 7.7% vs. 4.8%, P = 0.12, respectively). In the multivariable Cox proportional hazards models, there was no significant excess risk of the complex PCI group relative to the non-complex PCI group for the primary endpoint (HR, 1.35; 95%CI, 0.83–2.18; P = 0.22), or for any coronary revascularization (HR, 1.64; 95%CI, 0.87–3.06; P = 0.11). After optimal IVUS-guided multivessel PCI with a target lesion in the LAD, 1-year risk of MACCE or coronary revascularization in patients with complex PCI was numerically higher than that in patients with non-complex PCI.

Graphical Abstract