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

Ahmed, Mushood; Nadeem, Zain Ali; Ahsan, Areeba; Javaid, Hira; Jain, Hritvik; Shahid, Farhan; Ahmed, Raheel; Mamas, Mamas A.

Abstract

ABSTRACTBackgroundIntravascular 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.MethodsA 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.ResultsFifteen 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.ConclusionIVUS‐guided PCI reduced cardiac death, MACE, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared to angiography‐guided PCI.

Citation

Ahmed, M., Nadeem, Z. A., Ahsan, A., Javaid, H., Jain, H., Shahid, F., Ahmed, R., & Mamas, M. A. (in press). Intravascular Ultrasound‐Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review, Meta‐Analysis, and Meta‐Regression of Randomized Control Trials. Catheterization and Cardiovascular Interventions, 105(1), 68-271. https://doi.org/10.1002/ccd.31352

• Journal Article Type: Article
• Acceptance Date: Dec 1, 2024
• Online Publication Date: Dec 11, 2024
• Deposit Date: Jan 10, 2025
• Journal: Catheterization and Cardiovascular Interventions
• Print ISSN: 1522-1946
• Electronic ISSN: 1522-726X
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 105
• Issue: 1
• Pages: 68-271
• DOI: https://doi.org/10.1002/ccd.31352
• Keywords: angiography, intravascular ultrasound, percutaneous coronary intervention
• Public URL: https://keele-repository.worktribe.com/output/1020410