Intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention: Meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND

Previous meta-analyses have extensively compared the outcomes of intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention (PCI) in the treatment of coronary artery disease. However, conducting repeated meta-analyses within a short period may increase the probability of type I or type II errors. Therefore, we employed both traditional meta-analysis and trial sequential analysis (TSA) methods to compare the clinical outcomes of intravascular imaging-guided and coronary angiography-guided PCI.

METHODS

We searched PubMed, Cochrane Library, Embase, and Web of Science for literature comparing intravascular imaging-guided versus coronary angiography-guided PCI from inception to August 10, 2024. Four researchers, divided into 2 groups, independently extracted the data. The primary outcomes were major adverse cardiovascular events (MACEs) and target lesion failure (TLF). Secondary outcomes included stent thrombosis and all-cause mortality. TSA was used to analyze these outcomes.

RESULTS

A total of 23 randomized controlled trials with 17,766 participants were included. Compared to angiography, intravascular ultrasound has a significant advantage in reducing MACE (risk ratio [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.80) and TLF (RR: 0.64; 95% CI: 0.54-0.75) during follow-up, supported by high certainty of evidence and confirmed by an 80% power TSA, demonstrating a true positive effect. However, no significant differences were observed in reducing stent thrombosis or all-cause mortality. Similarly, compared to angiography, optical coherence tomography shows a significant advantage in reducing MACE beyond 1 year (RR: 0.79; 95% CI: 0.64-0.99), but further exploration is needed, given that only 3 studies were included. In other aspects, including the reduction of stent thrombosis and all-cause mortality, no significant differences were found.

CONCLUSION

Intravascular ultrasound showed truly superior efficacy in reducing MACE and TLF compared to angiography. However, additional studies are needed to further assess the effectiveness of optical coherence tomography.