{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:57:28Z","timestamp":1793325448929,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"Importance<\/jats:title>Although intravascular ultrasonography (IVUS) guidance promotes favorable outcomes after percutaneous coronary intervention (PCI), many catheterization laboratories worldwide lack access.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate whether systematic implementation of quantitative coronary angiography (QCA) to assist angiography-guided PCI could be an alternative strategy to IVUS guidance during stent implantation.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This randomized, open-label, noninferiority clinical trial enrolled adults (aged \u226518 years) with chronic or acute coronary syndrome and angiographically confirmed native coronary artery stenosis requiring PCI. Patients were enrolled in 6 cardiac centers in Korea from February 23, 2017, to August 23, 2021, and follow-up occurred through August 25, 2022. All principal analyses were performed according to the intention-to-treat principle.<\/jats:p><\/jats:sec>Interventions<\/jats:title>After successful guidewire crossing of the first target lesion, patients were randomized in a 1:1 ratio to receive either QCA- or IVUS-guided PCI.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was target lesion failure at 12 months, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. The trial was designed assuming an event rate of 8%, with the upper limit of the 1-sided 97.5% CI of the absolute difference in 12-month target lesion failure (QCA-guided PCI minus IVUS-guided PCI) to be less than 3.5 percentage points for noninferiority.<\/jats:p><\/jats:sec>Results<\/jats:title>The trial included 1528 patients who underwent PCI with QCA guidance (763; mean [SD] age, 64.1 [9.9] years; 574 males [75.2%]) or IVUS guidance (765; mean [SD] age, 64.6 [9.5] years; 622 males [81.3%]). The post-PCI mean (SD) minimum lumen diameter was similar between the QCA- and IVUS-guided PCI groups (2.57 [0.55] vs 2.60 [0.58] mm, P<\/jats:italic>\u2009=\u2009.26). Target lesion failure at 12 months occurred in 29 of 763 patients (3.81%) in the QCA-guided PCI group and 29 of 765 patients (3.80%) in the IVUS-guided PCI group (absolute risk difference, 0.01 percentage points [95% CI, \u20131.91 to 1.93 percentage points]; hazard ratio, 1.00 [95% CI, 0.60-1.68]; P<\/jats:italic>\u2009=\u2009.99). There was no difference in the rates of stent edge dissection (1.2% vs 0.7%, P<\/jats:italic>\u2009=\u2009.25), coronary perforation (0.2% vs 0.4%, P<\/jats:italic>\u2009=\u2009.41), or stent thrombosis (0.53% vs 0.66%, P<\/jats:italic>\u2009=\u2009.74) between the QCA- and IVUS-guided PCI groups. The risk of the primary end point was consistent regardless of subgroup, with no significant interaction.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Findings of this randomized clinical trial indicate that QCA and IVUS guidance during PCI showed similar rates of target lesion failure at 12 months. However, due to the lower-than-expected rates of target lesion failure in this trial, the findings should be interpreted with caution.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02978456<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2024.0059","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T15:11:38Z","timestamp":1710342698000},"page":"428","source":"Crossref","is-referenced-by-count":48,"title":["Quantitative Coronary Angiography vs Intravascular Ultrasonography to Guide Drug-Eluting Stent Implantation"],"prefix":"10.1001","volume":"9","author":[{"given":"Pil Hyung","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon 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