Comparing the impact of intravascular imaging, fractional flow reserve, and angiographic guidance on one-year outcomes of PCI in patients with chronic coronary syndromes: an emulated trial
B Ratanasumawong, P Robru, S Boonsorn, M Chandavimol, A Thakkinstian, T Limpijankit, S Siriyotha, N SukthienkarnAbstract
Background
Real-world evidence comparing clinical outcomes after percutaneous coronary intervention (PCI) using different guidance strategies, particularly among patients with chronic coronary syndromes (CCS) in Thailand, is limited. Although advanced technologies, including intracoronary physiology and intravascular imaging, can improve lesion assessment and procedural optimisation, their impact on 1-year major adverse cardiovascular events (MACE) outcomes remains uncertain.
Purpose
The aim of this study was to use a large real-world multicentre registry to compare 1-year MACE outcomes (myocardial infarction, stroke, death) among patients with CCS undergoing PCI guided by fractional flow reserve (FFR), intravascular imaging, or angiography alone, and to define the clinical outcomes associated with PCI revascularisation strategies in a real-world Thai population.
Methods
This study emulated a target trial using data from the Thai PCI registry, a nationwide multicentre prospective PCI registry. Among 19,701 patients, 8,135 with CCS were classified according to the use of angiography, FFR, or intravascular imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The primary outcome was 1-year MACE. Inverse probability weighting based on propensity scores was applied to balance baseline covariates and estimate comparative effects between strategies.
Results
At 1 year, MACE occurred in 858 patients (10.5%). Compared with angiography-only guided PCI, the estimated relative risk of MACE was 1.16 (95% confidence interval 0.98–1.35) with intravascular imaging (IVUS or OCT) guidance and 0.94 (95% confidence interval 0.22–1.67) with FFR guidance.
Conclusion
In patients with CCS undergoing PCI, FFR-guided and intravascular imaging-guided strategies were associated with similar 1-year MACE outcomes compared with angiography-only-guided PCI after adjustment for baseline differences. The results call for optimal utilisation of adjunctive intravascular technologies and proper operator training in real-world settings.Forest plot of Treatment effectCharacteristics of patients between group