Intravascular ultrasound (IVUS) significantly reduced the risk of major adverse cardiovascular events (OR 0.71) compared to conventional angiography, while optical coherence tomography (OCT) did not.
Meta-Analysis (n=17,572)
Yes
Does intravascular imaging-guided PCI (IVUS or OCT) reduce major adverse cardiovascular events compared to angiography-guided PCI in patients undergoing PCI?
Intravascular imaging guidance, particularly IVUS, significantly reduces the risk of MACE and cardiac death compared to conventional angiography during PCI.
Effect estimate: OR 0.71 (95% CI 0.56-0.87)
BACKGROUND: Percutaneous coronary intervention (PCI) has become one of the most commonly performed interventional life-saving procedures worldwide. Intravascular Imaging (intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) have initially evolved to guide PCI compared with angiography. However, this technology is not universally employed in all PCI procedures, and there is ongoing controversy regarding its additional benefits to patient outcomes. We aim to estimate the efficacy and safety of imaging modalities during PCI, allowing pre-, per, and post-intervention assessment of coronary vascularization. METHODS: A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs), which were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used R, version 4.2.0. Effect sizes will be presented as odds ratios with accompanying 95% credible intervals. PROSPERO ID: CRD42024507821. RESULTS: Our study, encompassing 36 RCTs with a total of 17,572 patients, revelead that compared to conventional angiography, IVUS significantly reduced the risk of major adverse cardiovascular events (MACE) (OR: 0.71 95% CrI: 0.56 to 0.87) but not OCT (OR: 0.91 95% CrI: 0.62 to 1.39), IVUS and OCT significantly reduced the risk of cardiac death (OR: 0.50 95% CrI: 0.33 to 0.76) and (OR: 0.55 95% CrI: 0.31 to 0.98), respectively, IVUS significantly reduced the risk of target vessel-related revascularization (OR: 0.60 95% CrI: 0.48 to 0.75) but not OCT (OR: 0.86 95% CrI: 0.60 to 1.19), IVUS and OCT significantly reduced the risk of stent thrombosis (OR: 0.50 95% CrI: 0.28 to 0.92) and (OR: 0.48 95% CrI: 0.22 to 0.98), respectively, IVUS significantly reduced the risk of re-stenosis (OR: 0.65 95% CrI: 0.46 to 0.88) but not OCT (OR: 0.55 95% CrI: 0.15 to 1.99), neither IVUS (OR: 0.97 95% CrI: 0.71 to 1.38) nor OCT (OR: 0.75 95% CrI: 0.49 to 1.22) were associated with statistically significant reductions in all-cause mortality, neither IVUS (OR: 0.70 95% CrI: 0.45 to 1.32) nor OCT (OR: 0.81 95% CrI: 0.47 to 1.59) were associated with statistically significant reductions in target vessel failure, neither IVUS (OR: 0.88 95% CrI: 0.43 to 2.44) nor OCT (OR: 0.81 95% CrI: 0.37 to 2.04) were associated with statistically significant reductions in target lesion failure, and neither IVUS (OR: 0.82 95% CrI: 0.60 to 1.06) nor OCT (OR: 0.84 95% CrI: 0.59 to 1.19) were associated with statistically significant reductions in myocardial infarction. CONCLUSION: Intravascular imaging-guided, including IVUS and OCT, improved the postinterventional outcomes of PCI, notably suggesting their advantage over traditional angiography with no significant difference between IVUS and OCT.
Amin et al. (2024) conducted a meta-analysis in Coronary artery disease requiring percutaneous coronary intervention (n=17,572). Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) vs. Conventional angiography was evaluated on Major adverse cardiovascular events (MACE) (OR 0.71, 95% CI 0.56-0.87). Intravascular ultrasound (IVUS) significantly reduced the risk of major adverse cardiovascular events (OR 0.71) compared to conventional angiography, while optical coherence tomography (OCT) did not.