Key result
Intravascular imaging-guided drug-eluting stent implantation significantly reduced the risk of target lesion revascularization (RR 0.63) compared to angiography-guided implantation.
Why the study?
Traditional angiography only provides two-dimensional views during stent implantation, whereas intravascular imaging visualizes vascular wall structure and plaque characteristics, prompting evaluation of its efficacy.
Does intravascular imaging-guided DES implantation reduce target lesion revascularization compared to traditional angiography-guided DES implantation in patients with coronary artery disease?
Meta-Analysis (n=7,307)
Yes
Does intravascular imaging-guided DES implantation reduce target lesion revascularization compared to traditional angiography-guided DES implantation in patients with coronary artery disease?
Effect estimate: RR 0.63 (95% CI 0.49-0.82)
Absolute Event Rate: 3.4% vs 5.7%
p-value: p=0.0004
Intravascular imaging-guided DES implantation significantly reduces the risk of target lesion revascularization, target vessel revascularization, cardiac death, MACE, and stent thrombosis compared to traditional angiography guidance, particularly in complex lesions.
Supports intravascular imaging for DES implantation in complex lesions; reinforces RCT evidence for fewer revascularizations and events.
BACKGROUND: Traditional angiography only displays two-dimensional images of the coronary arteries during stent implantation. However, intravascular imaging can show the structure of the vascular wall, plaque characteristics. This article aims to evaluate the efficacy of intravascular imaging-guided drug-eluting stent (DES) implantation. METHOD: We conducted a systematic review and meta-analysis of randomized controlled trials of intravascular imaging-guided, including patients with DES implantation guided by intravascular ultrasound or optical coherence tomography and traditional angiography. The databases of PubMed, EMBASE, web of science, and Cochrane Library were searched. The primary outcome was target lesion revascularization (TLR). The secondary outcomes included the target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), cardiac death, all-cause death, and the major adverse cardiac events (MACE) during the 6-24 months follow-up. The fixed-effects model was used to calculate the relative risk (RR) and 95% confidence interval of the outcome event. Meanwhile, the trial sequence analysis was employed to evaluate the results. RESULT: This meta-analysis included fourteen randomized controlled trials with 7307 patients. Compared with angiography-guided, intravascular imaging-guided DES implantation can significantly reduce the risk of TLR (RR 0.63, 0.49-0.82, P = 0.0004), TVR (RR 0.66, 0.52-0.85, P = 0.001), cardiac death (RR 0.58; 0.38-0.89; P = 0.01), MACE (RR 0.67, 0.57-0.79; P < 0.00001) and ST (RR 0.43, 0.24-0.78; P = 0.005). While there was no significant difference regarding MI (RR 0.77, 0.57-1.05, P = 0.10) and all-cause death (RR 0.87, 0.58-1.30, P = 0.50). CONCLUSIONS: Compared with angiography, intravascular imaging-guided DES implantation is associated with better clinical outcomes in patients with coronary artery disease, especially complex lesions (Registered by PROSPERO, CRD 42021289205).
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Niu et al. (2022) conducted a meta-analysis in Coronary artery disease (n=7,307). Intravascular imaging-guided (IVUS or OCT) drug-eluting stent implantation vs. Angiography-guided drug-eluting stent implantation was evaluated on Target lesion revascularization (TLR) (RR 0.63, 95% CI 0.49-0.82, p=0.0004). Intravascular imaging-guided drug-eluting stent implantation significantly reduced the risk of target lesion revascularization (RR 0.63) compared to angiography-guided implantation.
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