Using intravascular imaging to guide stent implantation during percutaneous coronary intervention (PCI) significantly improves survival and reduces adverse cardiovascular events compared to angiography-guided PCI, according to the largest clinical study of its kind, published in The Lancet. The study analyzed data from 15,964 patients across 22 trials and revealed that intravascular imaging methods, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), offer notable advantages over traditional angiography. Patients who underwent imaging-guided PCI experienced a 25% reduction in all-cause death, 45% reduction in cardiac death, 17% reduction in myocardial infarctions, and 48% reduction in stent thrombosis. Additionally, intravascular imaging improved outcomes related to target lesion revascularization and target vessel myocardial infarctions.
Unlike angiography, which relies on X-rays and contrast dye, IVUS and OCT provide high-resolution images that allow for precise measurements of artery size, plaque composition, and stent expansion. IVUS, introduced over three decades ago, and the newer OCT, which uses light for even higher-resolution imaging, address the limitations of angiography by offering superior visualization and diagnostic accuracy. Despite the proven benefits, IVUS is used in only 15–20% of cases in the U.S., and OCT in just 3%, primarily due to training challenges and reimbursement limitations.
Lead researcher Dr. Gregg W. Stone of Mount Sinai Health System emphasized the need to adopt these imaging techniques more widely, given their demonstrated ability to enhance the safety and effectiveness of coronary stenting. He called for better physician training and increased reimbursement to facilitate routine use. With reductions in cardiac deaths, heart attacks, and stent-related complications, this study underscores the transformative potential of intravascular imaging in improving outcomes for patients with coronary artery disease.
