- Question
- Does intravascular ultrasound (IVUS)-guided PCI improve clinical outcomes compared with angiography-guided PCI in patients with acute coronary syndrome treated with contemporary drug-eluting stents?
- Design
- Two-stage, multicentre, randomised trial of 3505 patients at 58 centres in China, Italy, Pakistan and the UK. Patients, follow-up providers and assessors were masked; catheterisation laboratory staff were not. The primary follow-up was 1 year.
- Population
- Adults aged 18 years or older presenting with an acute coronary syndrome and undergoing percutaneous coronary intervention.
- Intervention
- Drug-eluting stent implantation guided by IVUS, using predefined criteria for optimal stent deployment.
- Control
- Drug-eluting stent implantation guided by angiography alone.
- Primary outcome
- Target vessel failure at 1 year: a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularisation.
- Results
- Target vessel failure occurred in 70 patients in the IVUS group and 128 in the angiography group (Kaplan-Meier rate 4.0% vs 7.3%; HR 0.55; 95% CI 0.41-0.74; p=0.0001), driven by fewer target vessel myocardial infarctions and target vessel revascularisations. There were no significant differences in all-cause death or stent thrombosis.
- Safety
- Safety endpoints were similar between the two groups.
- Conclusion
- In acute coronary syndrome, IVUS guidance reduced 1-year target vessel failure compared with angiography guidance alone.
- Why it matters
- It provides acute coronary syndrome-specific evidence supporting the use of intracoronary imaging to guide PCI, reinforcing its broader use in this setting.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026