Evaluating IVUS-guided PCI in acute myocardial infarction: a comparative meta-analysis with angiography guidance

Intravascular ultrasound (IVUS) guidance shows benefits in various PCI settings; however, its impact in acute myocardial infarction (AMI) patients is not fully understood. This study aims to systematically review and meta-analyse the outcomes of IVUS-guided versus angiography-guided PCI in AMI. A comprehensive search across PubMed, Cochrane Library, Embase, Web of Science, and CNKI identified studies comparing IVUS- and angiography-guided PCI in AMI patients. Primary outcomes were all-cause mortality, major adverse cardiac events (MACE), cardiac death, and target vessel revascularization (TVR). A random-effects model was used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Nine studies with 838,902 patients (38,949 IVUS-guided and 796,953 angiography-guided) were included. IVUS-guided PCI significantly reduced all-cause mortality (RR 0.74, 95% CI 0.70-0.78, p < 0.001), MACE (RR 0.88, 95% CI 0.82-0.95, p = 0.001), cardiac death (RR 0.67, 95% CI 0.52-0.87, p = 0.003), and TVR (RR 0.86, 95% CI 0.75-0.98, p = 0.024) compared to angiography-guided PCI. Moderate heterogeneity was observed, but sensitivity analyses confirmed result stability. This meta-analysis indicates that IVUS-guided PCI in AMI patients improves clinical outcomes, including lower mortality, MACE, cardiac death, and TVR rates, compared to angiography guidance. Further research is needed to address barriers to wider IVUS adoption.