Intravascular Imaging–Guided or Angiography-Guided Complex PCI

   This prospective, multicenter randomized trial (RENOVATE-COMPLEX-PCI) compared intravascular imaging–guided versus angiography-guided percutaneous coronary intervention (PCI) in 1639 South Korean patients with complex coronary lesions. Patients were randomized 2:1 to receive PCI guided by either intravascular imaging (IVUS or OCT) or angiography. Over a median 2.1-year follow-up, the imaging-guided group had a significantly lower incidence of the composite primary endpoint (cardiac death, target-vessel myocardial infarction, or clinically driven revascularization) than the angiography group (7.7% vs. 12.3%; HR 0.64; P=0.008). Imaging-guided PCI also reduced cardiac death and MI risk with no safety trade-offs. Findings affirm imaging-guided PCI as superior for complex lesions, supporting guideline recommendations and optimizing stent outcomes through advanced visualization.

   This prospective, multicenter randomized trial (RENOVATE-COMPLEX-PCI) compared intravascular imaging–guided versus angiography-guided percutaneous coronary intervention (PCI) in 1639 South Korean patients with complex coronary lesions. Patients were randomized 2:1 to receive PCI guided by either intravascular imaging (IVUS or OCT) or angiography. Over a median 2.1-year follow-up, the imaging-guided group had a significantly lower incidence of the composite primary endpoint (cardiac death, target-vessel myocardial infarction, or clinically driven revascularization) than the angiography group (7.7% vs. 12.3%; HR 0.64; P=0.008). Imaging-guided PCI also reduced cardiac death and MI risk with no safety trade-offs. Findings affirm imaging-guided PCI as superior for complex lesions, supporting guideline recommendations and optimizing stent outcomes through advanced visualization.