Abstract
Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.
Tweetable abstract
A meta-analysis was conducted to compare intravascular ultrasound guidance/optical coherence tomography percutaneous coronary intervention with angiography percutaneous coronary intervention with target lesion revascularization as the primary outcome and target vessel revascularization, stent thrombosis, myocardial infarction, major adverse cardiovascular events, all cause death and cardiac death as the secondary outcomes.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1. Impact of intravascular ultrasound imaging on early and late clinical outcomes following percutaneous coronary intervention with drug-eluting stents. JACC Cardiovasc. Intervent. 4(9), 974–981 (2011).
- 2. . A practical approach to assessing stent results with IVUS or OCT. Methodist Debakey Cardiovasc. J. 14(1), 32–41 (2018). •• Presents a comprehensive and practical approach to percutaneous coronary intervention (PCI) using intravascular ultrasound (IVUS) or optical coherence tomography to optimize stent deployment and assess procedural complications after stent implantation.
- 3. Outcomes of optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation: one-year results from the ILUMIEN III: OPTIMIZE PCI trial. EuroIntervention 16(13), 1085–1091 (2021).
- 4. Intravascular imaging-guided or angiography-guided complex PCI. N. Engl. J. Med. 388(18), 1668–1679 (2023). • Trial assessing IVUS-guided implantation in association with major adverse cardiovascular events (MACE) and target vessel revascularization (TVR) in complex lesions.
- 5. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur. Heart J. 39(35), 3281–3300 (2018).
- 6. Angiography alone versus angiography plus optical coherence tomography to guide percutaneous coronary intervention: outcomes from the Pan-London PCI cohort. JACC Cardiovasc. Intervent. 11(14), 1313–1321 (2018). •• Reports that optical coherence tomography (OCT)-guided PCI was associated with improved procedural outcomes, in-hospital events, and long-term survival compared with standard angiography-guided PCI.
- 7. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339, b2700 (2009).
- 8. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343, d5928 (2011).
- 9. Long-term health outcome and mortality evaluation after invasive coronary treatment using drug eluting stents with or without the IVUS guidance. Randomized control trial. HOME DES IVUS. Catheter. Cardiovasc. Intervent. 75(4), 578–583 (2010).
- 10. A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial. Am. Heart J. 165(1), 65–72 (2013).
- 11. Randomized comparison of clinical outcomes between intravascular ultrasound and angiography-guided drug-eluting stent implantation for long coronary artery stenoses. JACC Cardiovasc. Intervent. 6(4), 369–376 (2013).
- 12. Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study. EuroIntervention 10(12), 1409–1417 (2015).
- 13. Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study. Circ. Cardiovasc. Intervent. 8(7), e002592 (2015).
- 14. Effect of intravascular ultrasound-guided drug-eluting stent implantation: 5-year follow-up of the IVUS-XPL randomized trial. JACC Cardiovasc. Intervent. 13(1), 62–71 (2020). •• Trial assessing IVUS-guided implantation in association with MACE and TVR in complex lesions.
- 15. . Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly. Saudi Med. J. 36(5), 549–553 (2015).
- 16. Intravascular ultrasound-guided drug-eluting stent implantation for patients with unprotected left main coronary artery lesions: a single-center randomized trial. Anatol. J. Cardiol. 21(2), 83–90 (2019). • Possible feasibility of IVUS-guided drug-eluting stent implantation for patients with unprotected left main coronary artery stenosis was supported by this study.
- 17. 3-year outcomes of the ULTIMATE trial comparing intravascular ultrasound versus angiography-guided drug-eluting stent implantation. JACC Cardiovasc. Intervent. 14(3), 247–257 (2021).
- 18. Optical coherence tomography versus intravascular ultrasound and angiography to guide percutaneous coronary interventions: the iSIGHT randomized trial. Circ. Cardiovasc. Intervent. 14(3), (2021).
- 19. . Efficacy of intravascular imaging-guided drug-eluting stent implantation: a systematic review and meta-analysis of randomized clinical trials. BMC Cardiovasc. Disord. 22(1), 327 (2022). •• A previous meta-analysis.
- 20. . Stenting of complex lesions: an overview. Nat. Rev. Cardiol. 7(9), 485–496 (2010).
- 21. Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: meta-analysis of randomized trials. Am. Heart J. 185, 26–34 (2017). •• A systematic meta-analysis comparing the use of angiography with drug-eluting stent implantation.
- 22. Effectiveness and safety of optical coherence tomography-guided PCI in Indian patients with complex lesions: a multicenter, prospective registry. Indian Heart J. 75(4), 236–242 (2023).
- 23. Comparison of angiographically guided direct stenting technique with direct stenting and optimal balloon angioplasty guided with intravascular ultrasound. The multicenter, randomized trial results. Am. Heart J. 154(4), 669–675 (2007). • Randomized controlled trial that hypothesized that the optimal coronary stenting outcomes might be compromised by employing appropriate stenting techniques.