CCTA-Guided PCI Noninferior to IVUS-Guided PCI

In a randomized, open-label, noninferiority trial, a coronary computed tomographic angiography (CCTA)–guided percutaneous coronary intervention (PCI) strategy was noninferior to intravascular ultrasound (IVUS)–guided PCI with respect to target-vessel failure at 12 months; among 1,105 randomized patients, target-vessel failure occurred in 4.1% of the CCTA-guided group versus 4.6% of the IVUS-guided group, with clinical procedural complications in 6 and 9 patients, respectively. CCTA provides anatomical and physiological information before catheterization that may enable PCI planning, yet data comparing CCTA-guided with IVUS-guided PCI on clinical outcomes have been lacking. In the investigator-initiated, international trial with blinded end-point adjudication, patients with a clinical indication for revascularization, at least one epicardial lesion with diameter stenosis greater than 70%, and a CCTA-derived fractional flow reserve of 0.80 or less were assigned 1:1 to CCTA-guided or IVUS-guided PCI; the primary end point was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization) at 12 months. The median patient age was 65 years, and 21.7% were women. The findings support CCTA-guided PCI as a viable alternative to IVUS-guided PCI. Source: https://www.nejm.org/