Coronary CT Angiography versus Intravascular Ultrasound Guidance for PCI.

In an international randomized trial of 1105 revascularization patients, CCTA-guided PCI was noninferior to IVUS-guided PCI for 12-month target-vessel failure (4.1% vs 4.6%).

• Why it matters: IVUS-guided PCI improves outcomes, but it is unclear whether CCTA-guided planning can match those clinical results while enabling pre-catheterization anatomical and physiological assessment.
• What they did: Patients with FFR derived from CCTA ≤0.80 and at least one epicardial lesion with >70% diameter stenosis were randomized 1:1 to CCTA-guided or IVUS-guided PCI; the primary endpoint was target-vessel failure at 12 months.
• The result: Target-vessel failure occurred in 23 (4.1%) vs 25 (4.6%) patients, with a risk difference of -0.42 percentage points (95% CI -2.82 to 1.99), supporting noninferiority and showing no superiority (P=0.73).

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