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Randomized Controlled Trial
. 2024 Feb 5;20(3):e198-e206.
doi: 10.4244/EIJ-D-23-00460.

Dynamic Coronary Roadmap versus standard angiography for percutaneous coronary intervention: the randomised, multicentre DCR4Contrast trial

Breda Hennessey  1   2 , Haim Danenberg  3   4 , Frédéric De Vroey  5 , Ajay J Kirtane  6 , Manish Parikh  6   7 , Dimitrios Karmpaliotis  6   8 , John C Messenger  9 , Aaron Strobel  9   10 , Alejandro Curcio  11 , Martijn S van Mourik  12 , Peter Eshuis  12 , Javier Escaned  1
Affiliations
Randomized Controlled Trial

Dynamic Coronary Roadmap versus standard angiography for percutaneous coronary intervention: the randomised, multicentre DCR4Contrast trial

Breda Hennessey et al. EuroIntervention. .

Abstract

Background: Decreasing the amount of iodinated contrast is an important safety aspect of percutaneous coronary interventions (PCI), particularly in patients with a high risk of contrast-induced acute kidney injury (CI-AKI). Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool projecting a motion-compensated virtual coronary roadmap overlay on fluoroscopy, potentially limiting the need for contrast during PCI.

Aims: This study investigates the contrast-sparing potential of DCR in PCI, compared to standard angiographic guidance.

Methods: The Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) trial is a multicentre, international, prospective, unblinded, stratified 1:1 randomised controlled trial. Patients were randomised to either DCR-guided PCI or to conventional angiography-guided PCI. The primary endpoint was the total volume of iodinated contrast administered, and the secondary endpoint was the number of cineangiography runs during PCI.

Results: The study population included 356 randomised patients (179 in DCR and 177 in control groups, respectively). There were no differences in patient demographics, angiographic characteristics or estimated glomerular filtration rate (eGFR) between the two groups. The total contrast volume used during PCI was significantly lower with DCR guidance compared with conventional angiographic guidance (64.6±44.4 ml vs 90.8±55.4 ml, respectively; p<0.001). The total number of cineangiography runs was also significantly reduced in the DCR group (8.7±4.7 vs 11.7±7.6 in the control group; p<0.001).

Conclusions: Compared to conventional angiography-guided PCI, DCR guidance was associated with a significant reduction in both contrast volume and the number of cineangiography runs during PCI. (ClinicalTrials.gov: NCT04085614).

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Conflict of interest statement

B. Hennessey is a speaker at educational events for Philips. H. Danenberg is a proctor for Medtronic and Edwards Lifesciences; and has received an institutional grant from Abbott. F. De Vroey is a speaker at educational events for Abbott. A.J. Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott, Amgen, CSI, Philips, ReCor Medical, Neurotronic, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, SoniVie, Shockwave Medical, and Merck; is a consultant for IMDS; and received travel expenses/meals from Amgen, Medtronic, Biotronik, Boston Scientific, Abbott, CathWorks, Edwards Lifesciences, CSI, Novartis, Philips, Abiomed, Merck, ReCor Medical, Chiesi, Zoll, Shockwave Medical, and Regeneron in addition to research grants, institutional funding received includes fees paid to Columbia University and/or Cardiovascular Research Foundation for consulting and/or speaking engagements in which Dr Kirtane controlled the content. M. Parikh has served on advisory boards for Medtronic, Boston Scientific, and Abbott. D. Karmpaliotis has received honoraria from Boston Scientific, Abbott, Teleflex, and Abiomed; and has equity in Saranas, Soundbite, Traverse Vascular, and Nanowear. J.C. Messenger has received institutional grant support from Philips Medical Systems. M.S. van Mourik is an employee of Philips Medical Systems. P. Eshuis is an employee of Philips Medical Systems. J. Escaned is an advisory board member and speaker at educational events for Philips. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Philips Dynamic Coronary Roadmap navigational tool for vessel wiring and stent placement.
A) A cineangiogram is obtained with a single contrast injection in the coronary arteries. B) Dynamic Coronary Roadmap (DCR) automatically converts this angiogram into a heart cycle of roadmap masks. C) For the subsequent live fluoroscopy image, DCR finds the best-matching roadmap mask and projects it as a real-time, motion-compensated dynamic overlay of the coronary tree (in red) on fluoroscopy to assist device navigation during PCI (D). PCI: percutaneous coronary intervention
Figure 2
Figure 2. Study flow of the DCR4Contrast randomised controlled trial.
DCR: Dynamic Coronary Roadmap; PCI: percutaneous coronary intervention
Figure 3
Figure 3. Primary and secondary outcomes of the DCR4Contrast randomised controlled trial.
A) Mean contrast volume used per PCI (primary objective) and B) mean number of cineangiograms obtained per PCI (secondary objective) in the DCR and control groups. The error bars represent the 95% confidence interval of the mean, and the p-value is based on log-transformed data. DCR: Dynamic Coronary Roadmap; PCI: percutaneous coronary intervention
Figure 4
Figure 4. Contrast volume outcomes for treated vessels’ SYNTAX score (SSv) subgroups.
Contrast volume used according to tertiles of SSv, showing an increasingly greater difference in contrast volume between randomised arms among procedures with higher SSv. DCR: Dynamic Coronary Roadmap; NS: not significant; PCI: percutaneous coronary intervention
Central illustration
Central illustration. Iodinated contrast volume utilisation in Dynamic Coronary Roadmap versus standard angiography-guided percutaneous coronary intervention: the randomised, multicentre DCR4Contrast trial.
DCR: Dynamic Coronary Roadmap; PCI: percutaneous coronary intervention
See this image and copyright information in PMC

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