Real-World Evaluation of PCI Guidance Using Dynamic Coronary Roadmap: A DCR4Contrast Trial Secondary Analysis.
Academic Article
Overview
abstract
BACKGROUND: Iodinated contrast used during percutaneous coronary intervention (PCI) risks contrast-induced acute kidney injury (CI-AKI). Reducing this risk is essential as PCI procedures become more complex. Dynamic Coronary Roadmap (DCR) is a PCI tool that overlays a virtual roadmap on fluoroscopy and has been shown to reduce contrast use. METHODS: This secondary analysis from the Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) study evaluates the feasibility of obtaining high-quality roadmaps suitable for PCI, its influence on contrast reduction and the relationship between PCI complexity and roadmap quality, and its effect on the contrast-sparing capabilities of DCR compared with standard angiographic guidance. The study was prospective and randomized, conducted in 6 centers across Europe (n = 3), Israel (n = 1), and the United States (n = 2). Patients were assigned to either DCR guidance or conventional guidance, and contrast usage and roadmap quality were compared. RESULTS: The study included 365 patients (181 DCR and 184 control). Both groups were comparable in demographics and procedure characteristics. The DCR arm showed clinically usable roadmap quality in 97.2% of cases. Contrast volume was significantly lower with DCR guidance and lowest when the roadmap scored better: 63.5 ± 50.3 mL for "DCR good" (n = 147) vs 79.3 ± 42.8 mL for "DCR fair/poor" (n = 34) vs 90.2 ± 53.3 mL for "Control" (n = 184) (P < .001). DCR's efficacy increased with PCI complexity (using the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery [SYNTAX]) score of the treated vessel [SSv] as an index): 71.4% of first tertile (SSv < 4), 79.7% of second tertile (4 ≤ SSv < 8), and 93.1% of third tertile (SSv ≥ 8) scored "very good" or "good" (P < .05). CONCLUSIONS: This multicenter study shows that DCR technology provides consistent high-quality roadmap support, reducing iodinated contrast usage significantly, particularly as PCI complexity increases.
