A large-scale study has shown that using intravascular imaging to guide stent implantation during percutaneous coronary intervention (PCI) significantly improves survival and reduces cardiovascular complications, compared to the commonly used angiography-guided method. The research, published in The Lancet, is the most comprehensive of its kind, evaluating two high-resolution imaging techniques—Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT). The study revealed that routine use of intravascular imaging led to a 25% reduction in all-cause death, 45% reduction in cardiac death, and a 17% reduction in heart attacks, as well as a 48% reduction in stent thrombosis.
This breakthrough is based on a synthesis of 22 trials involving nearly 16,000 patients from across the globe, with follow-up ranging from 6 months to 5 years. The findings emphasize the superior accuracy of IVUS and OCT over angiography, which has limitations in determining artery size, plaque composition, and stent expansion. While IVUS has been used for over 30 years, its adoption remains low due to interpretational challenges and limited reimbursement. OCT, a newer technique, offers even higher resolution but is used in only 3% of PCI cases due to lack of widespread evidence.
The study’s results underscore the importance of increasing the use of these advanced imaging methods to improve patient outcomes in coronary artery disease. Researchers advocate for overcoming barriers to widespread adoption, such as better training for medical staff and addressing reimbursement issues. According to Dr. Gregg Stone, the lead researcher, this study provides “hard evidence” that intravascular imaging guidance significantly enhances PCI outcomes, marking a pivotal step toward better clinical practices.
