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Several randomized clinical trials (RCTs) favor intravascular ultrasound (IVUS)-guided interventions over angiography solely. This study aims to compare the two-year clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with IVUS guidance versus angiography alone. Methods: We conducted a systematic search of major databases (PubMed, Cochrane, Embase) identifying 25 RCTs pertinent to our subject. Following further filtering, eight RCTs were included in our analysis. We Included 2414 patients (523 females) in IVUS group, 1897 patients (451 females) in angiography. Mean ages: IVUS 64.44 (9.44), angiography 64.28 (9.63) years. We used the Mantel-Haenszel method with a random-effects model with a p-value of < 0.05 for statistical significance to calculate the pooled risk ratio (RR) using IVUS as the experimental and angiography as the control group. Higgins I2 was used to assess heterogeneity. Results: There was a decreased risk of total lesion revascularization (TLR) (RR: 0.68; 95% CI = 0.51 - 0.91; p =0.01), total vessel revascularization (TVR) (RR: 0.68; 95% CI=0.53 - 0.87; p =0.002), stent thrombosis (RR: 0.33; 95% CI = 0.16- 0.65; p = 0.001), and cardiac death (RR: 0.52; 95% CI = 0.32 - 0.82; p = 0.005) in the IVUS group compared to the angiography group. However, no significant difference was noted in MACE (RR: 0.80; 95% CI = 0.62-1.02; p = 0.07), all-cause mortality (RR: 0.83; 95% CI = 0.61- 1.15; p = 0.27) and MI (RR: 0.86; 95% CI= 0.58 - 1.28; p = 0.46) between the two groups. In summary, IVUS-guided PCI demonstrates a lower risk of TLR, TVR, stent thrombosis, and cardiac death compared to angiography-guided PCI.
Turkmani et al. (Wed,) studied this question.