Intravascular image guidance during percutaneous coronary intervention lowers risk of death and myocardial infarction

1. Intravascular imaging-guided PCI significantly reduces target lesion failure compared to angiography-guided PCI.

2. The risks of stent thrombosis, all myocardial infarction, and all-cause mortality were significantly lower in the intravascular imaging guidance group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Previous meta-analyses have suggested the benefits of intravascular imaging-guided percutaneous coronary intervention (PCI) over angiography alone, however, they lacked the power to assess impacts on all-cause mortality or myocardial infarction. This systematic review and meta-analysis aimed to compare intravascular imaging-guided PCI with angiography-guided PCI using drug-eluting stents. The primary outcome of this study was target lesion failure, defined as a composite of cardiac death, target vessel-myocardial infarction (TV-MI), or target lesion revascularization, while a key secondary outcome was the incidence of stent thrombosis. According to study results, intravascular imaging-guided PCI significantly reduced the risk of target lesion failure and other adverse events, including stent thrombosis and all-cause death. This study was limited by the reliance on observational data and potential heterogeneity among included trials.

Click to read the study in The Lancet

Relevant Reading: Intravascular Imaging–Guided or Angiography-Guided Complex PCI

In-depth [systematic review and meta-analysis]: From database inceptions to Aug 30, 2023, a total of 22 trials were included in the meta-analysis. Patients undergoing PCI with drug-eluting stents were randomly assigned to receive intravascular imaging (ultrasound or optical coherence tomography [OCT]) or angiography alone. Altogether, 15,964 patients were followed for a mean duration of 24.7 months. The primary outcome of target lesion failure was markedly decreased in intravascular imaging-guided PCI versus angiography-guided PCI (relative risk [RR] 0.71, 95% confidence interval [CI] 0.63-0.80, p<0.0001). Likewise, secondary outcomes of the risk of stent thrombosis (RR 0.52, 95% CI 0.34-0.81, p=0.0036), all myocardial infarction (RR 0.83, 95% CI 0.71-0.99, p=0.033), and all-cause death (RR 0.75, 95% CI 0.60-0.93, p=0.0091) were lower in intravascular imaging. Findings from this study suggest that intravascular imaging guidance, whether with OCT or intravascular ultrasound, improves the safety and effectiveness of PCI.

Image: PD

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