한빛사논문
- 조회694
Woochan Kwon, MD1; Ki Hong Choi, MD, PhD1; Young Bin Song, MD, PhD1; Yong Hwan Park, MD, PhD2; Joo Myung Lee, MD, MPH, PhD1; Jong-Young Lee, MD, PhD3; Seung-Jae Lee, MD, PhD3; Sang Yeub Lee, MD, PhD4,5; Sang Min Kim, MD, PhD4; Kyeong Ho Yun, MD, PhD6; Jae Young Cho, MD, PhD6; Chan Joon Kim, MD, PhD7; Hyo-Suk Ahn, MD, PhD7; Chang-Wook Nam, MD, PhD8; Hyuck-Jun Yoon, MD, PhD8; Wang Soo Lee, MD, PhD9; Jin-Ok Jeong, MD, PhD10; Pil Sang Song, MD, PhD10; Joon-Hyung Doh, MD, PhD11; Sang-Ho Jo, MD, PhD12; Chang-Hwan Yoon, MD, PhD13; David Hong, MD1; Taek Kyu Park, MD, PhD1; Jeong Hoon Yang, MD, PhD1; Seung-Hyuk Choi, MD, PhD1; Hyeon-Cheol Gwon, MD, PhD1; Joo-Yong Hahn, MD, PhD1; for the RENOVATE COMPLEX-PCI Investigators
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
3Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
4Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
5Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
6Wonkwang University Hospital, Iksan, Korea
7The Catholic University of Korea, Uijeongbu St Mary’s Hospital, Seoul, Korea
8Keimyung University Dongsan Hospital, Daegu, Korea
9Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
10Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
11Inje University Ilsan Paik Hospital, Goyang, Korea
12Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
13Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
Corresponding Author: Young Bin Song, MD, PhD, Yong Hwan Park, MD, PhD
Drs Kwon and K.H. Choi equally contributed as first authors.
Drs Y.B. Song and Y. Park equally contributed as corresponding authors.
Abstract
Importance: As patients with chronic kidney disease (CKD) are more likely to have complex coronary lesions, intravascular imaging guidance in percutaneous coronary intervention (PCI) for this population could be potentially beneficial.
Objectives: To investigate whether the outcomes of intravascular imaging-guided procedural optimization would be different according to the presence of CKD.
Design, setting, and participants: This was a prespecified substudy of RENOVATE-COMPLEX-PCI, a recently published multicenter randomized clinical trial in Korea studying the benefits of intravascular imaging for complex coronary lesions. Patients with complex coronary lesions, with or without CKD, were enrolled between May 2018 and May 2021. Data were analyzed from January to June 2023.
Interventions: PCI in each group was done either under the guidance of intravascular imaging or angiography alone.
Main outcomes and measures: The primary end point was target vessel failure (TVF) at the 3-year point, defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.
Results: A total of 1639 patients (1300 male [79.3%]) treated with PCI for complex coronary lesions were stratified into CKD (296 participants) and non-CKD (1343 participants) groups. The mean (SD) age of each group was 70.3 (9.4) and 64.5 (10.1) years, and mean (SD) estimated serum creatinine was 2.9 (5.3) and 0.8 (0.2) mg/dL for CKD and non-CKD groups, respectively. Intravascular imaging-guided revascularization was associated with significantly lower incidence of the primary end point compared with angiography-guided revascularization in both CKD (13.3% vs 23.3%; hazard ratio [HR], 0.51; 95% CI, 0.27-0.93; P = .03) and non-CKD (6.4% vs 9.9%; HR, 0.66; 95% CI, 0.44-0.99; P = .05) groups. The significantly lower incidence of the primary end point was mainly associated with the lower risk of cardiac death or target vessel-related myocardial infarction (9.4% vs 22.2%; HR, 0.39; 95% CI, 0.20-0.76; P = .006) in the CKD group and by target vessel revascularization (3.0% vs 5.5%; HR, 0.55; 95% CI, 0.30-0.99; P = .05) in the non-CKD group. Those with a glomerular filtration rate of at least 30 mL/min/1.73m2 and less than 60 ml/kg/1.73m2 showed the greatest benefit from imaging-guided complex PCI (8.8% vs 21.2%; HR, 0.28; 95% CI, 0.11-0.68; P = .02).
Conclusions and relevance: In this prespecified cohort substudy of the Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention trial, intravascular imaging guidance showed clinical benefit over angiography guidance in reducing the risk of TVF, regardless of the presence of CKD. The greatest benefits of imaging-guided complex PCI were observed in stage 3 CKD.
논문정보
- Research article
- 2023년 11월 (BRIC 등록일 2023-11-30)
- 국내 연구진
- 의약학 > 응용의학
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