A physiology- and imaging-guided strategy for significant LAD disease favored CABG (49% vs 7%) and OMT (37% vs 3.3%) over PCI (19% vs 90%) compared to standard care (p<0.0001).
Observational (n=75)
Yes
Does a physiology- and imaging-guided treatment strategy (COMMIT-LAD) reduce MACE in symptomatic patients with hemodynamically significant LAD disease?
Incorporating intracoronary functional measurements to differentiate focal from diffuse LAD disease significantly alters treatment selection, favoring CABG and OMT over PCI.
Abstract Introduction Proper understanding of the severity and type (focal vs. diffuse) of coronary artery disease (CAD) is essential for optimizing its treatment. While percutaneous coronary intervention (PCI) is particularly effective in treating focal lesions, coronary artery bypass grafting (CABG) and optimal medical therapy (OMT) are probably more suitable in the setting of diffuse CAD. Purpose This registry aims to evaluate the relative effectiveness of surgical versus pharmacological treatments for patients with diffuse CAD. Additionally, it examines the impact of physiology- and imaging-guided PCI for focal CAD and assesses how the three major treatment strategies affect quality of life and angina status at 1-year follow-up. Methods This is an ongoing prospective, multicenter, real-world registry. Since January 1, 2024, we have been enrolling symptomatic patients with hemodynamically significant left anterior descending artery (LAD) disease with the involvement of the proximal segment (i.e., fractional flow reserve FFR ≤0.80, resting full-cycle ratio RFR ≤0.89). RFR pullback was used to discern focal and diffuse coronary artery disease. The COMMIT-LAD group comprised patients with diffuse LAD disease treated with OMT or CABG, and those with focal LAD lesions treated using OCT (Optical Coherence Tomography) guided PCI. Patients whose treatment plans deviate from physiological assessment results, or who have not undergone such an assessment, are registered in the Standard Strategy group. MACE (Major Adverse Cardiovascular Events) is the primary endpoint, while angina score and quality of life, assessed with the SAQ-7 (Seattle Angina Questionnaire-7) summary score, serve as secondary endpoints. Follow-up assessments were performed at 1, 3, 6, and 12 months. Results Between January 1 and November 30, 2024, 75 patients were enrolled: 30 in the Standard Strategy group and 45 in the COMMIT-LAD group. Baseline characteristics, including age, gender, and traditional health indicators, were similar between the two groups. All patients completed the 30-day follow-up, with just 1 MACE in the COMMIT-LAD group and no mortality events. The median SAQ-7 score was 24 (IQR: 16-29) vs. 27 (IQR: 21-28) at baseline, and 27 (IQR: 16-31) vs. 28 (IQR: 25-30) at 30 days for the standard and COMMIT-LAD groups, respectively. In the Standard Strategy group, PCI was more frequent while surgery was less common than in the COMMIT-LAD group (PCI: 90% vs 19%; CABG: 7% vs 49%; OMT: 3.3% vs 37%; standard vs COMMIT; p0.0001). Conclusion Incorporating intracoronary functional measurements into the assessment of stable CAD patients with significant LAD artery disease favors CABG and OMT over PCI. Our findings highlight the role of plaque burden assessment in guiding treatment decisions, and the completed registry data will provide valuable insights into its impact on clinical outcomes and quality of life.Baseline characteristics Treatment selection and follow-up
Bova et al. (2025) conducted an observational in Significant left anterior descending artery (LAD) disease (n=75). COMMIT-LAD strategy (physiology- and imaging-guided treatment) vs. Standard Strategy was evaluated on MACE (Major Adverse Cardiovascular Events). A physiology- and imaging-guided strategy for significant LAD disease favored CABG (49% vs 7%) and OMT (37% vs 3.3%) over PCI (19% vs 90%) compared to standard care (p<0.0001).