Using intravascular imaging to guide stent implantation during percutaneous coronary intervention (PCI) in heart disease patients significantly improves survival and reduces adverse cardiovascular events compared to angiography-guided PCI alone, the most commonly used method.

These are the results from the largest and most comprehensive clinical study of its kind comparing two types of intravascular imaging methods (intravascular ultrasound, or IVUS, and optical coherence tomography, or OCT) with angiography-guided PCI. The study, published Wednesday, February 21, in The Lancet, is the first to show that these two methods of high-resolution imaging can reduce all-cause death, heart attacks, stent thrombosis, and the need for revascularization.

“Our study, representing a synthesis of all early and recent clinical studies, has shown for the first time that the routine use of intravascular imaging guidance improves survival and enhances all aspects of the safety and effectiveness of coronary stenting, even with excellent contemporary drug-eluting stents,” says first author Gregg W. Stone, MD. Dr. Stone is Director of Academic Affairs for the Mount Sinai Health System, and Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai.

“Prior studies had shown benefits of intravascular imaging, but never to this extent,” Dr. Stone adds. “The addition of four recent trials in which 7,224 patients were enrolled now shows that intravascular imaging reduces all-cause death and all heart attacks across the wide range of patients who undergo stent treatment. As such, the routine use of intravascular imaging to guide stent implantation is one of the most effective therapies we have to improve the prognosis of patients with coronary artery disease.”

Patients with coronary artery disease—plaque buildup inside the arteries that leads to chest pain, shortness of breath, and heart attack—often undergo PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow. Interventional cardiologists most commonly use angiography to guide PCI, which involves a special dye (contrast material) and X-rays to see how blood flows through the heart arteries to highlight any blockages.

Angiography has limitations, however, making it difficult to determine the true artery size and the makeup of the plaque, and is suboptimal in identifying whether the stent is fully expanded post-PCI and in detecting other conditions that affect the early and late outcomes of the procedure. Intravascular ultrasound was introduced more than 30 years ago to provide a more accurate and specific picture of the coronary arteries. Even though studies have shown that IVUS-guided PCI is superior to angiography-guided PCI and reduces cardiovascular events, it is only used in roughly 15 to 20 percent of PCI cases in the United States, since the images may be difficult to interpret and the procedure is not fully reimbursed.

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