Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention for complex coronary lesions: A systematic review and meta-analysis.
Previous meta-analyses have suggested that intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces the risk of adverse outcomes compared with angiography-guided PCI in patients with coronary artery disease. However, several large-scale randomized controlled trials published recently have provided new evidence, necessitating an updated evaluation.
This updated meta-analysis aimed to compare the clinical effects of IVUS-guided PCI versus angiography-guided PCI in patients with complex coronary artery lesions.
Randomized controlled trials (RCTs) comparing IVUS-guided PCI with angiography-guided PCI in patients with complex coronary anatomy were systematically searched in PubMed/MEDLINE, EMBASE, and the Cochrane Library. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Sensitivity analyses and publication bias assessments were performed. The primary outcome was cardiac death. Secondary outcomes included all-cause death, myocardial infarction, stent thrombosis, any repeat revascularization, target lesion revascularization, and target vessel revascularization.
A total of 12 RCTs comprising 7089 patients were included, with a weighted mean follow-up of 18.0 months (range 12-24 months). Compared with angiography-guided PCI, IVUS-guided PCI was not associated with significant reductions in cardiac death (RR 1.02, 95% CI 0.76-1.38, P = 0.870), all-cause death (RR 0.97, 95% CI 0.77-1.22, P = 0.800), or myocardial infarction (RR 0.90, 95% CI 0.71-1.15, P = 0.370). However, IVUS guidance significantly reduced definite stent thrombosis (RR 0.31, 95% CI 0.12-0.77, P = 0.010), any repeat revascularization (RR 0.67, 95% CI 0.51-0.88, P = 0.007), target lesion revascularization (RR 0.73, 95% CI 0.55-0.97, P = 0.031), and target vessel revascularization (RR 0.70, 95% CI 0.52-0.95, P = 0.039). These revascularization benefits were attenuated and no longer statistically significant after trim-and-fill adjustment for potential publication bias.
In patients undergoing PCI for complex coronary artery lesions, IVUS-guided PCI did not reduce the incidence of cardiac death, all-cause death, or myocardial infarction compared with angiography-guided PCI. It was, however, associated with lower rates of definite stent thrombosis and repeat revascularization, although these benefits were sensitive to potential publication bias and largely driven by contemporary trials. These results support the selective use of IVUS-guidance for treatment of complex coronary lesions and call for further studies to optimize its use.
This updated meta-analysis aimed to compare the clinical effects of IVUS-guided PCI versus angiography-guided PCI in patients with complex coronary artery lesions.
Randomized controlled trials (RCTs) comparing IVUS-guided PCI with angiography-guided PCI in patients with complex coronary anatomy were systematically searched in PubMed/MEDLINE, EMBASE, and the Cochrane Library. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Sensitivity analyses and publication bias assessments were performed. The primary outcome was cardiac death. Secondary outcomes included all-cause death, myocardial infarction, stent thrombosis, any repeat revascularization, target lesion revascularization, and target vessel revascularization.
A total of 12 RCTs comprising 7089 patients were included, with a weighted mean follow-up of 18.0 months (range 12-24 months). Compared with angiography-guided PCI, IVUS-guided PCI was not associated with significant reductions in cardiac death (RR 1.02, 95% CI 0.76-1.38, P = 0.870), all-cause death (RR 0.97, 95% CI 0.77-1.22, P = 0.800), or myocardial infarction (RR 0.90, 95% CI 0.71-1.15, P = 0.370). However, IVUS guidance significantly reduced definite stent thrombosis (RR 0.31, 95% CI 0.12-0.77, P = 0.010), any repeat revascularization (RR 0.67, 95% CI 0.51-0.88, P = 0.007), target lesion revascularization (RR 0.73, 95% CI 0.55-0.97, P = 0.031), and target vessel revascularization (RR 0.70, 95% CI 0.52-0.95, P = 0.039). These revascularization benefits were attenuated and no longer statistically significant after trim-and-fill adjustment for potential publication bias.
In patients undergoing PCI for complex coronary artery lesions, IVUS-guided PCI did not reduce the incidence of cardiac death, all-cause death, or myocardial infarction compared with angiography-guided PCI. It was, however, associated with lower rates of definite stent thrombosis and repeat revascularization, although these benefits were sensitive to potential publication bias and largely driven by contemporary trials. These results support the selective use of IVUS-guidance for treatment of complex coronary lesions and call for further studies to optimize its use.
Authors
Ye Ye, Paredes Paredes, Diletti Diletti, Testa Testa, Daemen Daemen, de la Torre Hernandez de la Torre Hernandez, Dou Dou, Banning Banning, Spitzer Spitzer
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