Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Control Trials.

BACKGROUND

Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) allows better assessment of coronary artery lesion characteristics than angiography alone. This systematic review and meta-analysis aimed to comprehensively synthesize the available evidence regarding the efficacy of IVUS guidance compared to angiography-guided PCI.

METHODS

A comprehensive literature search of major bibliographic databases from inception until April 2024 was conducted to identify randomized control trials (RCTs) comparing IVUS-guided PCI versus angiography-guided PCI. Risk ratios (RR) with their corresponding 95% confidence intervals (CI) were pooled using the random-effects model, with a p < 0.05 considered statistically significant.

RESULTS

Fifteen RCTs were included with 9354 patients undergoing PCI. IVUS-guided PCI was associated with a lower risk of cardiac death [RR 0.49, 95% CI 0.33 to 0.72], major adverse cardiovascular events (MACE) [RR 0.64, 95% CI 0.51 to 0.80], myocardial infarction [RR 0.74, 95% CI 0.59 to 0.94], stent thrombosis [RR 0.48, 95% CI 0.29 to 0.81], target lesion revascularization [RR 0.60, 95% CI 0.48 to 0.75], and target vessel revascularization [RR 0.54, 95% CI 0.43 to 0.69] compared to angiography-guided PCI. IVUS-guided PCI was associated with a nonsignificant trend toward a reduced risk of all-cause mortality [RR 0.82, 95% CI 0.58 to 1.01]. Meta-regression showed a nonsignificant moderating effect of the duration of follow-up, age of patients, diabetes mellitus, and acute coronary syndrome presentation of patients on pooled outcomes.

CONCLUSION

IVUS-guided PCI reduced cardiac death, MACE, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared to angiography-guided PCI.