Effectiveness of a Zotarolimus-Eluting Stent (Resolute Onyx™) in Patients With Diffuse Long Coronary Artery Disease: Intravascular Ultrasound-guided vs. Angiography-guided Percutaneous Coronary Intervention

Abstract

Background Only a few studies have evaluated the efficacy of the Resolute Onyx™ zotarolimus-eluting stent (R-Onyx). Therefore, we aimed to assess the effectiveness of the R-Onyx stent in diffuse long coronary artery disease (CAD) and compare clinical outcomes between intravascular ultrasonography (IVUS)-guided and angiography-guided percutaneous coronary intervention (PCI).

Methods In total, 1,978 patients who underwent PCI with R-Onyx for diffuse long CAD were enrolled in this study. The primary endpoint was the cumulative incidence of major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, and target vessel revascularization. Clinical events were evaluated over a follow-up period of up to 12 months in the IVUS-guided PCI group (n = 1,064) and the angiography-guided PCI group (n = 914).

Results The mean age of study participants was 65.1 ± 11.9 years; 77.8% were men, and complex target lesions were present in 43.7% of the study population. The overall incidence of 12-month MACE was 2.7%. IVUS-guided PCI significantly reduced both the incidence and the risk of MACE compared to angiography-guided PCI among patients with anatomically complex target lesions (1.5% vs. 4.7%; adjusted hazard ratio, 0.34; 95% confidence interval, 0.14–0.86; P = 0.022).

Conclusions The R-Onyx stent demonstrated favorable 12-month clinical outcomes in patients with diffuse long CAD. Furthermore, IVUS-guided PCI provided superior clinical outcomes compared with angiography-guided PCI, particularly in patients with anatomically complex lesions.

Trial Registration ClinicalTrials.gov Identifier: NCT04825886