{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:29:33Z","timestamp":1787077773783,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Intravascular imaging (IVI) during percutaneous coronary intervention (PCI) improves outcomes. Pullback pressure gradient (PPG) characterizes coronary artery disease patterns as focal or diffuse; however, the benefit of IVI across this spectrum remains incompletely understood. We aimed to evaluate clinical outcomes after PCI with or without IVI guidance in patients with focal and diffuse disease defined by PPG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Prospective, multicenter, single-arm study of 811 patients (840 vessels) undergoing PCI. PPG was calculated from manual fractional flow reserve pullbacks to define focal (PPG \u22650.62) or diffuse coronary artery disease. IVI use was at the operator\u2019s discretion. The primary outcome was target vessel failure at 1-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      IVI-guided PCI was performed in 41% of patients. In the overall cohort, target vessel failure was lower with IVI guidance (adjusted hazard ratio, 0.60 [95% CI 0.36\u20130.99];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.044), with a lower incidence of cardiac death (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.042). IVI significantly reduced target vessel failure in focal disease (unadjusted HR, 0.41 [95% CI, 0.18\u20130.91];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.029), whereas no difference was observed in diffuse disease (unadjusted HR, 0.91 [95% CI, 0.48\u20131.73];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.771). There was no interaction between PPG and IVI guidance for target vessel failure (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction=0.128).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients undergoing physiology-guided PCI, the use of IVI reduced clinical events at 1 year. These findings suggest that the benefit of IVI extends across the full spectrum of coronary artery disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.126.016735","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T13:00:16Z","timestamp":1779282016000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Intravascular Imaging on Clinical Outcomes in Focal Versus Diffuse Coronary Artery Disease"],"prefix":"10.1161","volume":"19","author":[{"given":"Taito","family":"Arai","sequence":"first","affiliation":[{"name":"Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (T. Arai, K.I., H.Z., M.M., M.H., G.S.M., C.C.)."},{"name":"Cardiovascular Center Aalst, Belgium (T. Arai, K.S., K.I., T.M., F.B., J.S., A.W., M.H., D.M., B.D.B., C.C.)."},{"name":"Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan (T. Arai, K.S., T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0461-6497","authenticated-orcid":true,"given":"Koshiro","family":"Sakai","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Aalst, Belgium (T. Arai, K.S., K.I., T.M., F.B., J.S., A.W., M.H., D.M., B.D.B., C.C.)."},{"name":"Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan (T. Arai, K.S., T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1680-659X","authenticated-orcid":true,"given":"Kazumasa","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (T. Arai, K.I., H.Z., M.M., M.H., G.S.M., C.C.)."},{"name":"Cardiovascular Center Aalst, Belgium (T. Arai, K.S., K.I., T.M., F.B., J.S., A.W., M.H., D.M., B.D.B., C.C.)."},{"name":"Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Japan (K.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1086-8746","authenticated-orcid":true,"given":"Takuya","family":"Mizukami","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Aalst, Belgium (T. Arai, K.S., K.I., T.M., F.B., J.S., A.W., M.H., D.M., B.D.B., C.C.)."},{"name":"Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8642-0273","authenticated-orcid":true,"given":"Fr\u00e9d\u00e9ric","family":"Bouisset","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Aalst, Belgium (T. Arai, K.S., K.I., T.M., F.B., J.S., A.W., M.H., D.M., B.D.B., C.C.)."},{"name":"Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, France (F.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (T. Arai, K.I., H.Z., M.M., M.H., G.S.M., C.C.)."},{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.Z.)."},{"name":"Department of Cardiology, New York Presbyterian Hospital, Columbia University (H.Z., C.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2082-0247","authenticated-orcid":true,"given":"Mitsuaki","family":"Matsumura","sequence":"additional","affiliation":[{"name":"Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (T. 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