Abstract 15313: Prognostic Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Chronic Total Occlusion

Abstract

Background: Limited data exist regarding use of intravascular image during chronic total occlusion (CTO) intervention. Objectives: Current study investigated the prognostic impact of intravascular imaging-guided PCI in CTO lesions. Methods: Study population was derived from the RENOVATE-COMPLEX-PCI (n=1639) which demonstrated superiority of intravascular imaging-guided PCI than angiography-guided PCI in patients with complex coronary artery lesions. Current prespecified study selected patients who underwent CTO intervention and clinical outcomes were compared between intravascular imaging-guided PCI and angiography-guided PCI groups. Results: Among 1639 patients, 319 patients with CTO underwent intravascular imaging-guided PCI (n=220) or angiography-guided PCI (n=99). At a median follow-up of 2.1 years (interquartile range 1.1-3.0 years), the risk of TVF was significantly lower in intravascular imaging-guided PCI group than in the angiography-guided PCI group (5.0% vs. 13.5%; HR 0.303; 95% CI 0.130-0.710, P=0.006). When patients in imaging-guided PCI group were divided according to stent optimization, both patients with (1.3% vs. 13.5%; HR 0.14; 95% CI 0.02-0.56; P=0.003) and without (6.8% vs. 13.5%; HR 0.41; 95% CI 0.17-0.99; P=0.049) stent optimization had significantly lower risk of TVF than the angiography-guided PCI group. Conclusions: In patients with CTO, intravascular imaging-guided PCI was associated with reduced risk of TVF. Graded risk of TVF according to stent optimization by intravascular imaging supports the importance of intravascular imaging-guided PCI and achievement of stent optimization in CTO intervention.