The IVUS-CHIP trial randomized 2,020 patients undergoing complex, high-risk percutaneous coronary intervention (PCI) to either intravascular ultrasound (IVUS)-guided or standard angiography-guided stenting. Despite IVUS providing superior vessel visualization and more frequent post-stent balloon dilation, target-vessel failure rates at roughly 19 months were similar: 13.9% with IVUS versus 11.1% with angiography (HR 1.25; 95% CI 0.97–1.60; P=0.08). Procedural complications were also comparable. The trial challenges prior observational data and registry findings suggesting IVUS superiority, and raises questions about whether routine IVUS use with prespecified optimization criteria translates into measurable clinical benefit in a Western European practice setting.
