Comprehensive Summary
This study by Kim et al. investigates the effectiveness of an AI-QCA-assisted percutaneous coronary intervention (PCI) compared to optical coherence tomography (OCT)-guided PCI in terms of post-procedural results. The trial included 400 patients over the age of 19 experiencing significant coronary artery disease undergoing PCI from 13 sites in South Korea. Participants were randomly assigned in a 1:1 ratio to undergo either AI-QCA-assisted PCI or OCT-guided PCI following diagnostic coronary angiography. As a primary endpoint, the post-PCI MSA was 6.3 ± 2.2 mm2 in the AI-QCA group and 6.2 ± 2.2 mm2in the OCT group. There were no significant differences in overall stent expansion, stent underexpansion, or untreated reference segment disease among other OCT-defined endpoints. The study demonstrated that fully automated AI-QCA can provide real-time guidance for PCI and was noninferior to OCT-guided PCI.
Outcomes and Implications
The use of AI-QCA can be beneficial in a clinical setting as procedural efficiency can be improved while reducing the workflow interruptions associated with manual measurements. AI-QCA could be rapidly integrated into practice; however, since the study was conducted in South Korea, where imaging-guided PCI is more frequently performed, further validation of this system is necessary in non-Asian regions for generalization. Furthermore, this study focused on AI-QCA-guided stent sizing based on the analysis of native coronary artery before stenting, but further research should be explored post-stent for optimizing expansion and enhancing procedural precision. Nonetheless, AI-QCA could serve as an accessible alternative to OCT for guiding stent implantation, particularly in resource-limited settings.