Intravascular Imaging-guided PCI Outcomes — EECC MCQ

Correct answer: C — Yes — the IVUS-ACS, RENOVATE-COMPLEX, and OCTOBER trials demonstrate that intravascular imaging-guided PCI reduces MACE compared with angiography-alone in complex PCI

The correct answer is C. In contemporary PCI, intravascular imaging with either IVUS or OCT is used to optimise stent sizing, expansion, apposition and lesion coverage, and to detect problems such as edge dissection or malapposition that angiography can miss. Current evidence supports a clinical outcome benefit, particularly in ACS and anatomically complex PCI. IVUS-ACS showed that, in ACS patients undergoing DES PCI, IVUS guidance reduced 1-year target-vessel failure compared with angiography alone. RENOVATE-COMPLEX PCI showed fewer adverse cardiac events with IVUS/OCT-guided PCI in complex coronary lesions, and OCTOBER showed improved outcomes with OCT-guided PCI in complex bifurcation lesions. Therefore the exam answer is that intravascular imaging-guided PCI reduces MACE/target-vessel failure compared with angiography-guided PCI in complex PCI. It is not true that outcomes are identical, that only OCT is beneficial, that IVUS is ineffective, or that imaging is useful only in stable disease.

Reference: Li Z et al. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial. Lancet. 2024;403:1855-1865. https://doi.org/10.1016/S0140-6736(24)00282-4