Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis

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.

Summary points

• A total of 11 randomized controlled trials involving 6765 patients compared intravascular imaging-guided percutaneous coronary intervention (PCI; intravascular ultrasound and optical coherence tomography) with angiography-guided PCI for stent implantation in coronary lesions.

• Primary outcome analysis favored imaging-guided PCI, showing a significant reduction in target lesion revascularization.

• Secondary outcomes consistently favored imaging-guided PCI, including reductions in target vessel revascularization, cardiac death, major adverse cardiovascular events, stent thrombosis and myocardial infarction.

• The RENOVATE-COMPLEX-PCI trial specifically focused on complex coronary lesions and showed improved outcomes with intravascular imaging-guided PCI.

• Optical coherence tomography guidance during PCI has been shown to significantly reduce in-hospital major adverse cardiac events and mortality rates during long-term follow-up.

• A systematic meta-analysis comparing traditional angiography with intravascular imaging-guided drug-eluting stent (DES) implantation, focusing exclusively on randomized controlled trials, reinforced the benefits of imaging guidance.

• No significant difference in all-cause death was observed between the two groups, in accordance with previous meta-analyses.

• The findings suggest that intravascular imaging-guided PCI could enhance the success of stent implantation and improve clinical outcomes in patients with complex coronary lesions.

• Further research is needed to explore the benefits of intravascular imaging in diverse populations and with larger sample sizes, including studies involving new-generation DES.

• Caution should be exercised in interpreting the results, but the adoption of intravascular imaging-guided DES implantation appears justified based on observed benefits.

Keywords: :

• angiography
• coronary artery disease
• intravascular imaging
• meta analysis
• optical coherence tomography
• percutaneous coronary intervention

Author contributions

DA Ashraf: Project leader, review, manuscript writing, bias assessment, data extraction. U Ahmed: analysis and discussion. ZZ Khan: literature search and discussion writing. F Mushtaq: bias assessment and manuscript writing. S Bano: introduction writing. AR Khan: tables and data extraction. S Azam: analysis and bias assessment. A Haroon: data extraction and figures compilation. SA Malik: limitations and results writing. R Aslam: editing journal requirement. J Kumar: reviewer and mentor. FZ Khan: literature search and discussion writing. A Faheem: abstract writing. S Kumar: reviewer and mentor. S Hassan: final edits according to journal requirements.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.