Intravascular ultrasound-guided percutaneous coronary intervention significantly reduced the risk of major adverse cardiac events (RR 0.63) and stent thrombosis (RR 0.52) compared to angiography-guided intervention.
Meta-Analysis (n=10,280)
Does intravascular ultrasound (IVUS)-guided PCI reduce major adverse cardiac events and stent thrombosis compared to angiography-guided PCI in patients with coronary artery disease?
IVUS-guided PCI significantly reduces the risk of major adverse cardiac events and stent thrombosis compared to standard angiography-guided PCI, supporting its broader use in clinical practice.
Effect estimate: RR 0.63 (95% CI 0.50-0.79)
p-value: p=<0.001
This meta-analysis evaluated the clinical outcomes of intravascular ultrasound (IVUS)-guided versus angiography-guided percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). A comprehensive literature search was conducted across major electronic databases, identifying relevant studies published up to August 15, 2024. Thirteen randomized controlled trials (RCTs) met the inclusion criteria, comparing IVUS-guided and angiography-guided PCI. The primary outcomes were major adverse cardiac events (MACE) and stent thrombosis, while secondary outcomes included all-cause mortality, cardiac mortality, myocardial infarction, and revascularization rates. Pooled analysis revealed that IVUS-guided PCI significantly reduced the risk of MACE (risk ratio (RR): 0.63, 95% CI: 0.50-0.79) and stent thrombosis (RR: 0.52, 95% CI: 0.30-0.90) compared to angiography-guided PCI. Secondary outcomes also favored IVUS guidance, with significant reductions in cardiac mortality, myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR). While a trend towards reduced all-cause mortality was observed with IVUS guidance, it did not reach statistical significance. Notably, low heterogeneity across studies strengthened the reliability of these findings. Meta-regression analysis indicated that the presence of myocardial infarction did not significantly moderate the effect of IVUS on clinical outcomes, suggesting consistent benefits across patient subgroups. These results highlight the potential of IVUS-guided PCI to improve cardiovascular outcomes and reduce the need for repeat procedures. The findings support the growing body of evidence favoring IVUS use in PCI, particularly in complex lesions and high-risk patients. However, considerations such as cost-effectiveness and the need for specialized training remain important factors in the widespread adoption of IVUS-guided PCI in clinical practice.
Mohan et al. (Wed,) conducted a meta-analysis in Coronary artery disease (n=10,280). Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention vs. Angiography-guided percutaneous coronary intervention was evaluated on Major adverse cardiac events (MACE) (RR 0.63, 95% CI 0.50-0.79, p=<0.001). Intravascular ultrasound-guided percutaneous coronary intervention significantly reduced the risk of major adverse cardiac events (RR 0.63) and stent thrombosis (RR 0.52) compared to angiography-guided intervention.