Randomized Trial Comparing CT Angiography and Ultrasound Guidance for Treating Calcified Coronary Artery Disease with PCI

What this Trial Is About

Researchers are investigating whether a coronary CT angiography CCTA-guided calcium modification approach can improve the treatment of patients with significant calcified coronary artery disease undergoing percutaneous coronary intervention PCI. This prospective, multicenter, randomized controlled trial compares the CCTA-guided strategy to the current standard of care using intravascular ultrasound IVUS-guided PCI. The study aims to see if the CT-based approach can improve procedural efficiency and stent results while maintaining similar clinical outcomes to IVUS guidance. Participants will be randomly assigned to one of two groups one using CCTA to inform calcium modification and plaque preparation before PCI, and the other using IVUS imaging to guide the procedure. Both groups undergo imaging to evaluate lesion characteristics before the procedure, with IVUS also used after stent placement to confirm correct implantation. The trial includes two main goals showing superiority in minimal stent area by IVUS and demonstrating non-inferiority in 12-month target vessel failure rates. During the study, participants receive imaging and PCI treatments according to their assigned group. Researchers will collect data on procedure time, radiation exposure, contrast volume, and detailed stent measurements. Clinical safety outcomes such as myocardial infarction and stent thrombosis will be monitored up to 12 months, along with patient-reported angina symptoms. Total participant involvement spans the procedure and follow-up assessments to evaluate both imaging and clinical outcomes.

A Prospective, Multicenter, Randomized Controlled Trial to Investigate the Value of Coronary CT Angiography in the Understanding and Management of Coronary Calcium (The Optimal Trial)