The following is a summary of “Intravascular imaging-guided vs. angiography-guided percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials in high-risk patients and complex coronary anatomies,” published in the August 2024 issue of Cardiology by Teixeira et al.

Researchers conducted a retrospective study to assess the selective use of intravascular imaging (IVI) to guide percutaneous coronary intervention (PCI) of complex lesions and patients.

They carried out a systematic review and meta-analysis of RCTs. Embase, PubMed, and Cochrane were searched systematically for RCTs comparing IVI-guided PCI with angiography-guided in high-risk patients with PCI and those with complex coronary anatomies. The primary outcome was major adverse cardiac events (MACE). A random-effects model was applied to calculate the risk ratios (RRs) with 95% CIs.

The results showed 15 RCTs involving 14,109 patients, with a weighted mean follow-up of 15.8 months, indicated that IVI-guided PCI reduced the risk of MACE (RR: 0.65; 95% CI: 0.56–0.77; P<0.01), target vessel failure (TVF) (RR: 0.66; 95% CI: 0.52–0.84; P<0.01), all-cause mortality (RR: 0.71; 95% CI: 0.55–0.91; P<0.01), cardiovascular mortality (RR: 0.47; 95% CI: 0.34–0.65; P<0.01), stent thrombosis (RR: 0.55; 95% CI: 0.38–0.79; P<0.01), myocardial infarction (RR: 0.81; 95% CI: 0.67–0.98; P=0.03), and repeated revascularizations (RR: 0.70; 95% CI: 0.58–0.85; P<0.01) compared to angiography. No significant difference was observed in procedure-related complications (RR: 1.03; 95% CI: 0.75–1.42; P=0.84) between the 2 methods.

Investigators concluded that IVI-guided PCI of complex lesions and patients under high risk significantly improved clinical outcomes compared with angiographic guidance alone.

Source: internationaljournalofcardiology.com/article/S0167-5273(24)01132-X/abstract