Research Finds No Added Benefit From Routine Ct Imaging After Left Main Coronary Intervention

Routine coronary computed tomography (CCT)-based follow-up aft percutaneous coronary involution (PCI) of nan near main coronary artery did not trim death, myocardial infarction (MI), unstable angina aliases stent thrombosis compared pinch symptom-based follow-up, according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

The near main coronary artery supplies a ample proportionality of nan bosom musculus and important near main coronary artery illness is associated pinch precocious morbidity and mortality. The preamble of coronary stents on pinch nan improvements successful exertion and pharmacological guidance has accrued nan usage of PCI successful these high-risk patients pinch akin results achieved compared pinch coronary artery bypass grafting.

Detrimental complications, specified arsenic stent restenosis, and recurrent ischemic events tin hap aft near main PCI; however, nan optimal surveillance strategy remains a taxable of debate. In caller years, CCT has emerged arsenic a valuable instrumentality for diagnosis and monitoring, providing accuracy comparable to invasive angiography, while minimising procedural risks and reducing healthcare costs. We conducted nan first randomized proceedings to measure nan imaginable use of regular CCT-based follow-up astatine 6 months compared pinch modular symptom- and ischemia-driven guidance successful patients aft PCI for near main disease."

Doctor Ovidio De Filippo, trial presenter, from Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy

PULSE was an open-label, blinded-endpoint, investigator-initiated, randomized proceedings conducted astatine 15 sites successful Europe and South America.

Participants were consecutive patients pinch captious stenosis undergoing PCI for near main coronary artery disease. Participants were randomized 1:1 to either a CCT-guided follow-up astatine 6 months (experimental arm) aliases modular denotation and ischemia-driven guidance (control arm). Participants were followed for an further 12 months (total follow-up 18 months).

In nan CCT arm, if important near main in-stent restenosis was detected, patients underwent invasive coronary angiography followed by target lesion revascularisation if in-stent restenosis was confirmed. If immoderate important stenosis was detected successful a different site, guidance was conducted according to nan existent guidelines. In nan standard-of-care arm, patients were managed per objective guidelines and according to each centre's modular practice. The superior endpoint was a composite of all-cause death, spontaneous MI, unstable angina aliases definite/probable stent thrombosis astatine 18 months.

A full of 606 patients were randomized who had a mean property of 69 years and 18% were female. CCT was performed successful 89.8% of patients successful nan experimental limb astatine a median of 200 days.

A primary-endpoint arena occurred successful 11.9% of patients successful nan CCT limb and 12.5% of patients successful nan power limb astatine 18 months (hazard ratio [HR] 0.97; 95% assurance interval [CI] 0.76 to 1.23; p=0.80).

There was a reduced consequence of spontaneous MI successful nan CCT limb vs. nan power limb (0.9% vs. 4.9%; HR 0.26; 95% CI 0.07 to 0.91; p=0.004). An summation successful imaging-triggered target-lesion revascularisation was observed successful nan CCT limb compared pinch nan power limb (4.9% vs. 0.3%; HR 7.7; 95% CI 1.70 to 33.7; p=0.001); however, nan incidence of clinically driven target-lesion revascularisation was akin betwixt nan arms (5.3% vs. 7.2%; HR 0.74; 95% CI 0.38 to 1.41; p=0.32).

Summing up nan main findings, Principal Investigator, Professor Fabrizio D'Ascenzo, besides from Hospital Citta Della Salute e della Scienza di Torino, said: "Systematic 6-month CCT-based follow-up did not consequence successful a simplification successful 18-month all-cause death, spontaneous MI, unstable angina and stent thrombosis. While cosmopolitan CCT-based follow-up whitethorn not beryllium useful, nan marked simplification successful spontaneous MI and recognition of obstructive lesions requiring repetition PCI propose this attack whitethorn beryllium worthy investigating further successful selected patients pinch analyzable anatomies and complete longer follow-up."