The impact of intravascular imaging on percutaneous coronary intervention outcomes in acute myocardial infarction: a systematic review and meta-analysis

Background Intravascular imaging (IVI) facilitates optimal outcomes in percutaneous coronary intervention (PCI). Focused data on the impact of IVI on outcomes of PCI in acute myocardial infarction (AMI), in particular, are scarce. Methods A systematic search of the PubMed, EMBASE, Medline, and Cochrane databases was conducted from their inception to 1 December 2024 for studies comparing IVI to coronary angiography alone to guide PCI in AMI. Outcomes of interest included all-cause mortality (primary), cardiac mortality, major adverse cardiovascular events (MACE), recurrent myocardial infarction, target vessel revascularization (TVR), stent thrombosis, and target lesion revascularization (TLR). Random effects models were used to calculate relative risks (RRs) with 95% confidence intervals (CIs). Results Fourteen studies (43 547 patients) met inclusion criteria; nine studies reported all-cause mortality. Among patients with AMI, compared with coronary angiography alone, patients with IVI-guided PCI had lower all-cause mortality (RR: 0.76, 95% CI: 0.64–0.89; P < 0.01). IVI had less cardiac death (RR: 0.71, 95% CI: 0.59–0.86; P < 0.01), MACE (RR: 0.85, 95% CI: 0.77–0.94; P < 0.01), recurrent MI (RR: 0.84, 95% CI: 0.71–99; P = 0.04), TVR (RR: 0.79, 95% CI: 0.70–0.89; P < 0.01), and stent thrombosis (RR: 0.69, 95% CI: 0.53–0.90; P = 0.01). TLR was not significantly different between IVI and coronary angiography alone. Conclusion Among patients with AMI, IVI-guided PCI is associated with improved clinical outcomes compared with coronary angiography alone. Further high-quality randomized trials are needed to clarify the magnitude of benefit.