Coronary Artery DiseaseRENOVATENCT03381872
Intravascular Imaging- Versus Angiography-Guided Percutaneous Coronary Intervention For Complex Coronary Artery Disease
A study testing Percutaneous coronary intervention for complex lesion, Drug-eluting stent and Intravascular imaging (IVUS or OCT) in people with Coronary Artery Disease and Atherosclerosis, run by Samsung Medical Center at 1 site in South Korea.
Trial summary
The aim of the study is to compare clinical outcomes between intravascular imaging-guided versus angiography-guided percutaneous coronary intervention (PCI) in complex lesions. Read more about this study
- Who is it for?
- Ages 19 years and older
- Conditions the study is for
- Coronary Artery Disease, Atherosclerosis
- What is being tested?
- Percutaneous coronary intervention for complex lesion, Drug-eluting stent and Intravascular imaging (IVUS or OCT)
- Type of treatment
- Medical device, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1,639 participants
- Where
- 1 siteSouth Korea
- Study dates
- 10 May 2018to 31 Dec 2025
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Subject age ≥19 years old
- Coronary artery disease requiring PCI
- Patients with complex lesion
- True bifurcation lesion (Medina 1,1,1/1,0,1/0,1,1) with side branch ≥2.5mm size
- Chronic total occlusion (≥3 months) as target lesion
- Unprotected LM disease PCI (LM ostium, body, distal LM bifurcation including non-true bifurcation)
Show all 13Show fewer
- Long coronary lesions (implanted stent ≥38 mm in length)
- Multi-vessel PCI (≥2 vessels treated at one PCI session)
- Multiple stents needed (≥3 more stent per patient)
- In-stent restenosis lesion as target lesion
- Severely calcified lesion (encircling calcium in angiography)
- Ostial coronary lesion (LAD, LCX, RCA)
- Subject is able to verbally confirm understandings of risks, benefits and treatment alternatives of receiving invasive physiologic evaluation and PCI and he/she or his/her legally authorized representative provides written informed consent prior to any study related procedure.
Who cannot join
- Target lesions not amenable for PCI by operators' decision
- Cardiogenic shock (Killip class IV) at presentation
- Intolerance to Aspirin, Clopidogrel, Prasugrel, Ticagrelor, Heparin, or Everolimus
- Known true anaphylaxis to contrast medium (not allergic reaction but anaphylactic shock)
- Pregnancy or breast feeding
- Non-cardiac co-morbid conditions are present with life expectancy <1 year or that may result in protocol non-compliance (per site investigator's medical judgment)
- Unwillingness or inability to comply with the procedures described in this protocol.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention (RENOVATE-COMPLEX-PCI)
The aim of the study is to compare clinical outcomes between intravascular imaging-guided versus angiography-guided percutaneous coronary intervention (PCI) in complex lesions.
Read the detailed description
After introduction of the 2nd generation drug-eluting stents (DES), the rates of device-related failure or target lesion failure such as restenosis and stent thrombosis has been markedly decreased, compared with the era of bare metal stents or 1st generation DES. Nevertheless, patients undergoing percutaneous coronary intervention (PCI) for complex lesions, for example, chronic total occlusion (CTO), left main disease, true bifurcation lesion, long lesion, multi-vessel PCI, multiple overlapping stents, or severely calcified lesions have significantly worse clinical outcomes than those with non-complex lesions.
During the PCI procedure, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are useful tools for providing information on preintervention lesion characteristics, including vulnerable plaques, lesion severity, length, and morphology; on postintervention optimal stent implantation for stent expansion, extension, and apposition; and on possible complications after stent implantation. Therefore, intravascular imaging guidance may improve clinical outcomes after complex PCI. However, although previous randomized controlled trial (RCT) and registries showed significantly lower rates of major adverse clinical events following IVUS-guided PCI compared with angiography-guided PCI, the RCTs were limited with small sample size and dealt with very selected lesion subsets such as CTO or long lesion. Moreover, it is uncertain whether OCT-guided PCI improves clinical outcomes compared with angiography-guided PCI. Meanwhile, appropriate imaging modality may differ according to patient and lesion characteristics.
One of the ways to maximize the advantage of intravascular imaging is choice of intravascular imaging devices by the operator's discretion. Therefore, the current RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) is designed to investigate whether PCI under guidance of intravascular imaging devices (IVUS or OCT) chosen by operators would improve clinical outcomes compared with angiography-guided PCI in patients with complex lesions.
- Conditions
- Coronary Artery Disease, Atherosclerosis
- Being tested
- Percutaneous coronary intervention for complex lesion, Drug-eluting stent, Intravascular imaging (IVUS or OCT), Drug-coated balloon
- Keywords
- Intravascular Imaging, Intravascular Ultrasound, Optical Coherence Tomography, Complex Lesion, Percutaneous Coronary Intervention
- Medical subject headings
- Coronary Artery Disease, Atherosclerosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Percutaneous coronary intervention for complex lesionProcedure or surgery
In patients who have complex coronary lesions, PCI will performed using intravascular imaging or angiography only according to the allocated arms
- Intravascular imaging arm
- Angiography arm
- Definition of Complex Lesions
- True bifurcation lesion (Medina 1,1,1/1,0,1/0,1,1) with side branch ≥2.5mm size
- Chronic total occlusion (≥3 months) as target lesion
- PCI for unprotected left main (LM) disease (LM os, body, distal LM bifurcation including non-true bifurcation)
- Implanted stent length ≥38mm
- Multi-vessel PCI (≥2 major epicardial coronary arteries treated at one PCI session)
- Multiple stent needed (≥3 more stent per patient)
- In-stent restenosis lesion as target lesion
- Severely calcified lesion (encircling calcium in angiography)
- Ostial coronary lesion (LAD, LCX, RCA)
Drug-eluting stentDevice
All patient will be received percutaneous coronary intervention with second generation drug-eluting stent or drug-coated balloon.
Intravascular imaging (IVUS or OCT)Device
IVUS Reference site: Largest lumen, Plaque burden <50% Stent sizing: By measuring vessel diameter (external elastic membrane) at proximal and distal reference sites. The averaged value of the proximal and distal reference external elastic membrane diameter will be used as stent diameter
OCT Reference site: Most normal looking segment, No Lipidic plaque Stent sizing: [1] By measuring vessel diameter at the distal reference sites (in case of ≥180° of the external elastic membrane can be identified). In this case, stent diameter will be determined using mean external elastic membrane diameter at the distal reference, rounded down to the nearest 0.25 mm.
[2] By measuring lumen diameter at the distal reference sites (in case of ≥180° of the external elastic membrane cannot be identified). In this case, stent diameter will be determined using mean lumen diameter at the distal reference, rounded up to the nearest 0.25 mm.
Drug-coated balloonDevice
All patient will be received percutaneous coronary intervention with second generation drug-eluting stent or drug-coated balloon.
| Study group | Role | What they receive |
|---|---|---|
| Intravascular imaging arm | Active comparator | The choice of intravascular imaging devices such as IVUS or OCT during PCI will be left to the operator's discretion. In case of staged procedure during the same hospitalization, following the initially allocated strategy would be strongly recommended. Use of intravascular imaging devices will be allowed at any step of PCI (pre-PCI, during PCI and post-PCI), but intravascular imaging evaluation after stent implantation will be mandatory. Receives: Procedure: Percutaneous coronary intervention for complex lesion; Device: Drug-eluting stent; Device: Intravascular imaging (IVUS or OCT); Device: Drug-coated balloon |
| Angiography arm | Active comparator | The PCI procedure in this group will be performed as standard procedure. After deployment of stent, stent optimization will be done based on angiographic findings. The optimization guided by angiography should meet the criteria of angiographic residual diameter stenosis less than 10% by visual estimation and the absence of flow limiting dissection (≥Type C dissection). When angiographic under-expansion of the stent is suspected, adjunctive balloon dilatation will be strongly recommended. In case of staged procedure during the same hospitalization, following the initially allocated strategy would be strongly recommended. Receives: Procedure: Percutaneous coronary intervention for complex lesion; Device: Drug-eluting stent; Device: Drug-coated balloon |
What is being measured
The primary outcome is the main question the study is designed to answer.
Target vessel Failure
A composite of cardiac death, target vessel MI, and clinically-driven target vessel revascularization
Measured: 1-year after last patient enrollment
Secondary outcomes (32)
Target vessel failure without procedure-related MI
A composite of cardiac death, spontaneous target vessel MI, and clinically-driven target vessel revascularization
Measured: 1-year after last patient enrollment
Cardiac death or target-vessel related MI
Cardiac death or target-vessel related MI
Measured: 1-year after last patient enrollment
All-cause death
any death
Measured: 1-year after last patient enrollment
Cardiac death
cardiac death
Measured: 1-year after last patient enrollment
Target vessel MI with procedure-related MI
Target vessel MI with procedure-related MI
Measured: 1-year after last patient enrollment
Target vessel MI without procedure-related MI
Target vessel MI without procedure-related MI
Measured: 1-year after last patient enrollment
Any MI with procedure-related MI
Any MI with procedure-related MI
Measured: 1-year after last patient enrollment
Any MI without procedure-related MI
Any MI without procedure-related MI
Measured: 1-year after last patient enrollment
Non-target vessel related MI
Non-target vessel related MI
Measured: 1-year after last patient enrollment
Target lesion revascularization
TLR
Measured: 1-year after last patient enrollment
Target vessel revascularization
TVR
Measured: 1-year after last patient enrollment
Any revascularization
clinically-driven revascularization
Measured: 1-year after last patient enrollment
Stent thrombosis
definite stent thrombosis
Measured: 1-year after last patient enrollment
Incidence of contrast-induced nephropathy
CIN was defined as an increase in serum creatinine of ≥0.5mg/dL or ≥25% from baseline within 48-72 hours after contrast agent exposure
Measured: 48-72 hours after index procedure
Total amount of contrast use
Total amount of contrast use during index hospitalization
Measured: Immediate after index procedure
Total procedure time
Total procedure time during index hospitalization
Measured: Immediate after index procedure
Total medical cost
Total medical cost
Measured: 1-year after last patient enrollment
Target vessel Failure
A composite of cardiac death, target vessel MI, and clinically-driven target vessel revascularization
Measured: 4 years after last patient enrollment
Target vessel failure without procedure-related MI
A composite of cardiac death, spontaneous target vessel MI, and clinically-driven target vessel revascularization
Measured: 4 years after last patient enrollment
All-cause death
any death
Measured: 4 years after last patient enrollment
Cardiac death
cardiac death
Measured: 4 years after last patient enrollment
Target vessel MI with procedure-related MI
Target vessel MI with procedure-related MI
Measured: 4 years after last patient enrollment
Target vessel MI without procedure-related MI
Target vessel MI without procedure-related MI
Measured: 4 years after last patient enrollment
Any MI with procedure-related MI
Any MI with procedure-related MI
Measured: 4 years after last patient enrollment
Any MI without procedure-related MI
Any MI without procedure-related MI
Measured: 4 years after last patient enrollment
Non-target vessel related MI
Non-target vessel related MI
Measured: 4 years after last patient enrollment
Target lesion revascularization
TLR
Measured: 4 years after last patient enrollment
Target vessel revascularization
TVR
Measured: 4 years after last patient enrollment
Any revascularization
clinically-driven revascularization
Measured: 4 years after last patient enrollment
Stent thrombosis
definite stent thrombosis
Measured: 4 years after last patient enrollment
Bleeding (BARC definition)
BARC Classification (2,3, or 5)
Measured: 4 years after last patient enrollment
Bleeding (TIMI definition)
TIMI Classification (Minimal, Minor, Major)
Measured: 4 years after last patient enrollment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Dec 2017
- Study start10 May 2018
- Primary completion10 May 2022
- Study completion31 Dec 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (13)Papers the sponsor has linked to this study.
- Other trials for Coronary Artery DiseaseStudies of the same condition, open and under way.
- More trials run by Samsung Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Prospective, open label, two-arm, randomized controlled trial
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 1,639 participants (actual)
Sponsor and investigators
- Lead sponsor
- Samsung Medical Center
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Joo-Yong Hahn, Samsung Medical Center
- Investigators
- Joo-Yong Hahn, MD, PhD, Principal investigator, Samsung Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03381872
- Sponsor's protocol ID
- Renovate16453143
- Acronym
- RENOVATE
- Status last verified
- Aug 2025
- First submitted
- 16 Dec 2017
- Last updated
- 22 Aug 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: After publication of first manuscript and trial results, the de-identified data will be shared by permission of principle investigator, when asked
Publications
Lee JM, Kim O, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE COMPLEX-PCI Investigators. Intravascular Imaging- vs Angiography-Guided Complex PCI: 5-Year Outcomes From a Randomized Trial. J Am Coll Cardiol. 2026 Apr 28;87(16):2099-2113. doi: 10.1016/j.jacc.2026.01.035. Epub 2026 Mar 4.
PubMed 41778943Jo J, Lee SY, Kwon W, Lee SJ, Lee JY, Lee SH, Shin D, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee SY, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI in Patients With High Bleeding Risk: A Secondary Analysis of the RENOVATE-COMPLEX PCI Trial. Circ Cardiovasc Interv. 2025 Mar;18(3):e014952. doi: 10.1161/CIRCINTERVENTIONS.124.014952. Epub 2025 Mar 18.
PubMed 40100948Lee JM, Lee SY, Kwon W, Lee SJ, Lee JY, Lee SH, Shin D, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs. Circ Cardiovasc Interv. 2025 Feb;18(2):e014920. doi: 10.1161/CIRCINTERVENTIONS.124.014920. Epub 2025 Feb 18.
PubMed 39965046Lee SY, Lee SJ, Kwon W, Lee SH, Shin D, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee JY, Lee JM, Investigators TR. Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity. EuroIntervention. 2025 Feb 3;21(3):e171-e182. doi: 10.4244/EIJ-D-24-00755.
PubMed 39901632Hong D, Ha J, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Park TK, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Prognostic impact of intravascular imaging in percutaneous coronary intervention according to atherothrombotic risk: a post hoc analysis of a randomized clinical trial. Rev Esp Cardiol (Engl Ed). 2025 Jun;78(6):542-552. doi: 10.1016/j.rec.2024.11.007. Epub 2024 Dec 4. English, Spanish.
PubMed 39643207Choi KH, Park TK, Song YB, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Yang JH, Choi SH, Gwon HC, Hahn JY, Nam CW; RENOVATE COMPLEX-PCI Investigators. Intravascular Imaging and Angiography Guidance in Complex Percutaneous Coronary Intervention Among Patients With Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jun 3;7(6):e2417613. doi: 10.1001/jamanetworkopen.2024.17613.
PubMed 38913377Lee SY, Choi KH, Kim CJ, Lee JM, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Kim SE, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE-COMPLEX-PCI Investigators. Impact of Intravascular Imaging-Guided Stent Optimization According to Clinical Presentation in Patients Undergoing Complex PCI. JACC Cardiovasc Interv. 2024 May 27;17(10):1231-1243. doi: 10.1016/j.jcin.2024.03.021.
PubMed 38811104Cha JH, Lee JM, Choi KH, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Lee WS, Song YB; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided Optimization of Complex Percutaneous Coronary Intervention by Sex: A Subgroup Analysis of the RENOVATE-COMPLEX-PCI Trial. JAMA Cardiol. 2024 May 1;9(5):466-474. doi: 10.1001/jamacardio.2024.0291.
PubMed 38568686Hong D, Lee J, Lee H, Cho J, Guallar E, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Kang D, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI: Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial. Circ Cardiovasc Qual Outcomes. 2024 Mar;17(3):e010230. doi: 10.1161/CIRCOUTCOMES.123.010230. Epub 2024 Mar 13.
PubMed 38477162Kwon W, Hong D, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided Percutaneous Coronary Intervention Before and After Standardized Optimization Protocols. JACC Cardiovasc Interv. 2024 Jan 22;17(2):292-303. doi: 10.1016/j.jcin.2023.10.062.
PubMed 38267144Kwon W, Choi KH, Song YB, Park YH, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE COMPLEX-PCI Investigators. Intravascular Imaging in Patients With Complex Coronary Lesions and Chronic Kidney Disease. JAMA Netw Open. 2023 Nov 1;6(11):e2345554. doi: 10.1001/jamanetworkopen.2023.45554.
PubMed 38019512Kwon W, Lee JM, Yun KH, Choi KH, Lee SJ, Lee JY, Lee SY, Kim SM, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Song YB; RENOVATE COMPLEX-PCI Investigators. Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention. Circ Cardiovasc Interv. 2023 Dec;16(12):e013359. doi: 10.1161/CIRCINTERVENTIONS.123.013359. Epub 2023 Nov 29.
PubMed 38018841Lee JM, Choi KH, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided or Angiography-Guided Complex PCI. N Engl J Med. 2023 May 4;388(18):1668-1679. doi: 10.1056/NEJMoa2216607. Epub 2023 Mar 5.
PubMed 36876735
Study at a glance
From the registry record, last updated by the sponsor on 22 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention (RENOVATE-COMPLEX-PCI)
- ClinicalTrials.gov ID
- NCT03381872
- Acronym / sponsor ID
- RENOVATE / Renovate16453143
- Conditions
- Coronary Artery Disease, Atherosclerosis
- Keywords
- Intravascular Imaging, Intravascular Ultrasound, Optical Coherence Tomography, Complex Lesion, Percutaneous Coronary Intervention
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 1,639 participants (actual)
- Lead sponsor
- Samsung Medical CenterUniversity, hospital or other
- Study start
- 10 May 2018 (actual)
- Primary completion
- 10 May 2022 (actual)
- Study completion
- 31 Dec 2025 (estimated)
- First posted
- 22 Dec 2017 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The aim of the study is to compare clinical outcomes between intravascular imaging-guided versus angiography-guided percutaneous coronary intervention (PCI) in complex lesions.
Detailed description
After introduction of the 2nd generation drug-eluting stents (DES), the rates of device-related failure or target lesion failure such as restenosis and stent thrombosis has been markedly decreased, compared with the era of bare metal stents or 1st generation DES. Nevertheless, patients undergoing percutaneous coronary intervention (PCI) for complex lesions, for example, chronic total occlusion (CTO), left main disease, true bifurcation lesion, long lesion, multi-vessel PCI, multiple overlapping stents, or severely calcified lesions have significantly worse clinical outcomes than those with non-complex lesions.
During the PCI procedure, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are useful tools for providing information on preintervention lesion characteristics, including vulnerable plaques, lesion severity, length, and morphology; on postintervention optimal stent implantation for stent expansion, extension, and apposition; and on possible complications after stent implantation. Therefore, intravascular imaging guidance may improve clinical outcomes after complex PCI. However, although previous randomized controlled trial (RCT) and registries showed significantly lower rates of major adverse clinical events following IVUS-guided PCI compared with angiography-guided PCI, the RCTs were limited with small sample size and dealt with very selected lesion subsets such as CTO or long lesion. Moreover, it is uncertain whether OCT-guided PCI improves clinical outcomes compared with angiography-guided PCI. Meanwhile, appropriate imaging modality may differ according to patient and lesion characteristics.
One of the ways to maximize the advantage of intravascular imaging is choice of intravascular imaging devices by the operator's discretion. Therefore, the current RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) is designed to investigate whether PCI under guidance of intravascular imaging devices (IVUS or OCT) chosen by operators would improve clinical outcomes compared with angiography-guided PCI in patients with complex lesions.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- Prospective, open label, two-arm, randomized controlled trial
| Arm | Type | Receives |
|---|---|---|
| Intravascular imaging arm | Active comparator | Procedure: Percutaneous coronary intervention for complex lesion, Device: Drug-eluting stent, Device: Intravascular imaging (IVUS or OCT), Device: Drug-coated balloonThe choice of intravascular imaging devices such as IVUS or OCT during PCI will be left to the operator's discretion. In case of staged procedure during the same hospitalization, following the initially allocated strategy would be strongly recommended. Use of intravascular imaging devices will be allowed at any step of PCI (pre-PCI, during PCI and post-PCI), but intravascular imaging evaluation after stent implantation will be mandatory. |
| Angiography arm | Active comparator | Procedure: Percutaneous coronary intervention for complex lesion, Device: Drug-eluting stent, Device: Drug-coated balloonThe PCI procedure in this group will be performed as standard procedure. After deployment of stent, stent optimization will be done based on angiographic findings. The optimization guided by angiography should meet the criteria of angiographic residual diameter stenosis less than 10% by visual estimation and the absence of flow limiting dissection (≥Type C dissection). When angiographic under-expansion of the stent is suspected, adjunctive balloon dilatation will be strongly recommended. In case of staged procedure during the same hospitalization, following the initially allocated strategy would be strongly recommended. |
Who may qualify
- Ages
- 19 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (13 listed)
- Subject age ≥19 years old
- Coronary artery disease requiring PCI
- Patients with complex lesion
- Subject is able to verbally confirm understandings of risks, benefits and treatment alternatives of receiving invasive physiologic evaluation and PCI and he/she or his/her legally authorized representative provides written informed consent prior to any study related procedure.
Key exclusion criteria (7 listed)
- Target lesions not amenable for PCI by operators' decision
- Cardiogenic shock (Killip class IV) at presentation
- Intolerance to Aspirin, Clopidogrel, Prasugrel, Ticagrelor, Heparin, or Everolimus
- Known true anaphylaxis to contrast medium (not allergic reaction but anaphylactic shock)
- Pregnancy or breast feeding
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Percutaneous coronary intervention for complex lesionIn patients who have complex coronary lesions, PCI will performed using intravascular imaging or angiography only according to the allocated arms 1. Intravascular imaging arm 2. Angiography arm * Definition of Complex Lesions 1. True bifurcation lesion (Medina 1,1,1/1,0,1/0,1,1) with side branch ≥2.5mm size 2. Chronic total occlusion (≥3 months) as target lesion 3. PCI for unprotected left main (LM) disease (LM os, body, distal LM bifurcation including non-true bifurcation) 4. Implanted stent length ≥38mm 5. Multi-vessel PCI (≥2 major epicardial coronary arteries treated at one PCI session) 6. Multiple stent needed (≥3 more stent per patient) 7. In-stent restenosis lesion as target lesion 8. Severely calcified lesion (encircling calcium in angiography) 9. Ostial coronary lesion (LAD, LCX, RCA) | Procedure or surgery | Angiography arm, Intravascular imaging arm |
| Drug-eluting stentAll patient will be received percutaneous coronary intervention with second generation drug-eluting stent or drug-coated balloon. | Device | Angiography arm, Intravascular imaging arm |
| Intravascular imaging (IVUS or OCT)IVUS Reference site: Largest lumen, Plaque burden <50% Stent sizing: By measuring vessel diameter (external elastic membrane) at proximal and distal reference sites. The averaged value of the proximal and distal reference external elastic membrane diameter will be used as stent diameter OCT Reference site: Most normal looking segment, No Lipidic plaque Stent sizing: [1] By measuring vessel diameter at the distal reference sites (in case of ≥180° of the external elastic membrane can be identified). In this case, stent diameter will be determined using mean external elastic membrane diameter at the distal reference, rounded down to the nearest 0.25 mm. [2] By measuring lumen diameter at the distal reference sites (in case of ≥180° of the external elastic membrane cannot be identified). In this case, stent diameter will be determined using mean lumen diameter at the distal reference, rounded up to the nearest 0.25 mm. | Device | Intravascular imaging arm |
| Drug-coated balloonAll patient will be received percutaneous coronary intervention with second generation drug-eluting stent or drug-coated balloon. | Device | Angiography arm, Intravascular imaging arm |
Primary outcome
Target vessel Failure
Time frame: 1-year after last patient enrollment
A composite of cardiac death, target vessel MI, and clinically-driven target vessel revascularization
32 secondary outcomes
Target vessel failure without procedure-related MI
Time frame: 1-year after last patient enrollment
Cardiac death or target-vessel related MI
Time frame: 1-year after last patient enrollment
All-cause death
Time frame: 1-year after last patient enrollment
Cardiac death
Time frame: 1-year after last patient enrollment
Target vessel MI with procedure-related MI
Time frame: 1-year after last patient enrollment
Target vessel MI without procedure-related MI
Time frame: 1-year after last patient enrollment
Any MI with procedure-related MI
Time frame: 1-year after last patient enrollment
Any MI without procedure-related MI
Time frame: 1-year after last patient enrollment
Non-target vessel related MI
Time frame: 1-year after last patient enrollment
Target lesion revascularization
Time frame: 1-year after last patient enrollment
Target vessel revascularization
Time frame: 1-year after last patient enrollment
Any revascularization
Time frame: 1-year after last patient enrollment
Stent thrombosis
Time frame: 1-year after last patient enrollment
Incidence of contrast-induced nephropathy
Time frame: 48-72 hours after index procedure
Total amount of contrast use
Time frame: Immediate after index procedure
Total procedure time
Time frame: Immediate after index procedure
Total medical cost
Time frame: 1-year after last patient enrollment
Target vessel Failure
Time frame: 4 years after last patient enrollment
Target vessel failure without procedure-related MI
Time frame: 4 years after last patient enrollment
All-cause death
Time frame: 4 years after last patient enrollment
Cardiac death
Time frame: 4 years after last patient enrollment
Target vessel MI with procedure-related MI
Time frame: 4 years after last patient enrollment
Target vessel MI without procedure-related MI
Time frame: 4 years after last patient enrollment
Any MI with procedure-related MI
Time frame: 4 years after last patient enrollment
Any MI without procedure-related MI
Time frame: 4 years after last patient enrollment
Non-target vessel related MI
Time frame: 4 years after last patient enrollment
Target lesion revascularization
Time frame: 4 years after last patient enrollment
Target vessel revascularization
Time frame: 4 years after last patient enrollment
Any revascularization
Time frame: 4 years after last patient enrollment
Stent thrombosis
Time frame: 4 years after last patient enrollment
Bleeding (BARC definition)
Time frame: 4 years after last patient enrollment
Bleeding (TIMI definition)
Time frame: 4 years after last patient enrollment
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Aug 2025.
- Derived from this study: PubMed 41778943Lee JM, Kim O, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE COMPLEX-PCI Investigators. Intravascular Imaging- vs Angiography-Guided Complex PCI: 5-Year Outcomes From a Randomized Trial. J Am Coll Cardiol. 2026 Apr 28;87(16):2099-2113. doi: 10.1016/j.jacc.2026.01.035. Epub 2026 Mar 4.
- Derived from this study: PubMed 40100948Jo J, Lee SY, Kwon W, Lee SJ, Lee JY, Lee SH, Shin D, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee SY, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI in Patients With High Bleeding Risk: A Secondary Analysis of the RENOVATE-COMPLEX PCI Trial. Circ Cardiovasc Interv. 2025 Mar;18(3):e014952. doi: 10.1161/CIRCINTERVENTIONS.124.014952. Epub 2025 Mar 18.
- Derived from this study: PubMed 39965046Lee JM, Lee SY, Kwon W, Lee SJ, Lee JY, Lee SH, Shin D, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs. Circ Cardiovasc Interv. 2025 Feb;18(2):e014920. doi: 10.1161/CIRCINTERVENTIONS.124.014920. Epub 2025 Feb 18.
- Derived from this study: PubMed 39901632Lee SY, Lee SJ, Kwon W, Lee SH, Shin D, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Choi KH, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee JY, Lee JM, Investigators TR. Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity. EuroIntervention. 2025 Feb 3;21(3):e171-e182. doi: 10.4244/EIJ-D-24-00755.
- Derived from this study: PubMed 39643207Hong D, Ha J, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Park TK, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Prognostic impact of intravascular imaging in percutaneous coronary intervention according to atherothrombotic risk: a post hoc analysis of a randomized clinical trial. Rev Esp Cardiol (Engl Ed). 2025 Jun;78(6):542-552. doi: 10.1016/j.rec.2024.11.007. Epub 2024 Dec 4. English, Spanish.
- Derived from this study: PubMed 38913377Choi KH, Park TK, Song YB, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Yang JH, Choi SH, Gwon HC, Hahn JY, Nam CW; RENOVATE COMPLEX-PCI Investigators. Intravascular Imaging and Angiography Guidance in Complex Percutaneous Coronary Intervention Among Patients With Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jun 3;7(6):e2417613. doi: 10.1001/jamanetworkopen.2024.17613.
- Derived from this study: PubMed 38811104Lee SY, Choi KH, Kim CJ, Lee JM, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Kim SE, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE-COMPLEX-PCI Investigators. Impact of Intravascular Imaging-Guided Stent Optimization According to Clinical Presentation in Patients Undergoing Complex PCI. JACC Cardiovasc Interv. 2024 May 27;17(10):1231-1243. doi: 10.1016/j.jcin.2024.03.021.
- Derived from this study: PubMed 38568686Cha JH, Lee JM, Choi KH, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Lee WS, Song YB; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided Optimization of Complex Percutaneous Coronary Intervention by Sex: A Subgroup Analysis of the RENOVATE-COMPLEX-PCI Trial. JAMA Cardiol. 2024 May 1;9(5):466-474. doi: 10.1001/jamacardio.2024.0291.
- Derived from this study: PubMed 38477162Hong D, Lee J, Lee H, Cho J, Guallar E, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Kang D, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI: Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial. Circ Cardiovasc Qual Outcomes. 2024 Mar;17(3):e010230. doi: 10.1161/CIRCOUTCOMES.123.010230. Epub 2024 Mar 13.
- Derived from this study: PubMed 38267144Kwon W, Hong D, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee JM; RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging-Guided Percutaneous Coronary Intervention Before and After Standardized Optimization Protocols. JACC Cardiovasc Interv. 2024 Jan 22;17(2):292-303. doi: 10.1016/j.jcin.2023.10.062.
- Derived from this study: PubMed 38019512Kwon W, Choi KH, Song YB, Park YH, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY; RENOVATE COMPLEX-PCI Investigators. Intravascular Imaging in Patients With Complex Coronary Lesions and Chronic Kidney Disease. JAMA Netw Open. 2023 Nov 1;6(11):e2345554. doi: 10.1001/jamanetworkopen.2023.45554.
- Derived from this study: PubMed 38018841Kwon W, Lee JM, Yun KH, Choi KH, Lee SJ, Lee JY, Lee SY, Kim SM, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Song YB; RENOVATE COMPLEX-PCI Investigators. Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention. Circ Cardiovasc Interv. 2023 Dec;16(12):e013359. doi: 10.1161/CIRCINTERVENTIONS.123.013359. Epub 2023 Nov 29.
- Individual participant dataSharing planned: Yes. After publication of first manuscript and trial results, the de-identified data will be shared by permission of principle investigator, when asked
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Joo-Yong Hahn, MD, PhD principal investigator
Samsung Medical Center
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Percutaneous coronary intervention for complex lesion, Drug-eluting stent and Intravascular imaging (IVUS or OCT) in people with Coronary Artery Disease and Atherosclerosis, run by Samsung Medical Center at 1 site in South Korea.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 13 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 22 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Target vessel Failure (time frame: 1-year after last patient enrollment). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03381872, which also lists 13 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Aug 2025.