Discussion
coronary artery lesions, cardiac death, CKD, uremia
CARDIAC DEATH, ISCHEMIC HEART DISEASE, UREMIA
In this prespecified substudy of the RENOVATE-COMPLEX-PCI, we aimed to investigate whether the benefit of intravascular imaging–guided PCI differs according to the presence of CKD. A summary of the findings is as follows. First, patients with CKD had a 2-fold higher risk of TVF than those without CKD after PCI for complex coronary artery lesions. Second, the intravascular imaging guidance during complex PCI was associated with significantly reduced risk of TVF compared with angiography guidance, regardless of the CKD presence. The lower incidence of the primary end point was primarily due to a lower risk of cardiac death or target vessel–related MI in patients with CKD, but target vessel revascularization in those without CKD. Third, the greatest benefit of intravascular imaging guidance for TVF during complex PCI was shown in patients with stage 3 CKD (30≤GFR<60 mL/min/1.73mCKD is a well-known risk factor for ischemic heart disease, not only for the high prevalence of concomitant cardiovascular risk factors, but also for the pathologic effect of uremia on the cardiovascular system.The use of intravascular imaging during PCI offers comprehensive anatomical insights into the coronary artery, facilitates optimal stent selection, and enhances the optimization of stent implantation. In addition, IVUS (not OCT) can suppress kidney function deterioration by minimizing contrast volume during PCI in patients with CKD, as has been suggested by several small studies.Interestingly, we found that the clinical benefits of intravascular imaging guidance during complex PCI were greatest in patients with stage 3 CKD (GFR, >30 mL/min/1.73 m