NYMC Faculty Publications

Intravascular Imaging-Guided versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Trials

Author Type(s)

Faculty

DOI

10.1161/JAHA.123.031111

Journal Title

Journal of the American Heart Association

First Page

e031111

Document Type

Article

Publication Date

1-16-2024

Department

Medicine

Keywords

intravascular ultrasound, meta‐analysis, optical coherence tomography, percutaneous coronary intervention

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study-level meta-analysis comparing intravascular imaging to angiography to guide PCI was performed. This study aimed to evaluate the clinical outcomes of intravascular imaging-guided PCI compared with angiography-guided PCI. METHODS AND RESULTS: A random-effects meta-analysis was performed on the basis of the intention-to-treat principle. The primary outcomes were major adverse cardiac events, cardiac death, and all-cause death. Mixed-effects meta-regression was performed to investigate the impact of complex PCI on the primary outcomes. A total of 16 trials with 7814 patients were included. The weighted mean follow-up duration was 28.8 months. Intravascular imaging led to a lower risk of major adverse cardiac events (relative risk [RR], 0.67 [95% CI, 0.55-0.82]; <0.001), cardiac death (RR, 0.49 [95% CI, 0.34-0.71]; <0.001), stent thrombosis (RR, 0.63 [95% CI, 0.40-0.99]; =0.046), target-lesion revascularization (RR, 0.67 [95% CI, 0.49-0.91]; =0.01), and target-vessel revascularization (RR, 0.60 [95% CI, 0.45-0.80]; <0.001). In complex lesion subsets, the point estimate for imaging-guided PCI compared with angiography-guided PCI for all-cause death was a RR of 0.75 (95% CI, 0.55-1.02; =0.07). CONCLUSIONS: In patients undergoing PCI, intravascular imaging is associated with reductions in major adverse cardiac events, cardiac death, stent thrombosis, target-lesion revascularization, and target-vessel revascularization. The magnitude of benefit is large and consistent across all included studies. There may also be benefits in all-cause death, particularly in complex lesion subsets. These results support the use of intravascular imaging as standard of care and updates of clinical guidelines.

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