Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: A...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Current guidelines suggest intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) in left main coronary artery disease (LM CAD).
• Evidence comparing IVUS-guided versus angiography-guided PCI in LM CAD requires comprehensive synthesis.

Purpose of the Study:

• To compare the effectiveness of IVUS-guided PCI versus angiography-guided PCI in patients with LM CAD.
• To evaluate the impact of IVUS guidance on mortality and other adverse events in LM CAD patients.

Main Methods:

• Systematic literature search of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials.
• Inclusion of 10 studies (1 randomized, 9 non-randomized) with 6,480 patients comparing IVUS-guided with angiography-guided PCI in LM CAD.
• Primary outcome assessed was mortality (all-cause and cardiac death).

Main Results:

• IVUS-guided PCI was associated with significantly lower risks of all-cause death (RR 0.60) and cardiac death (RR 0.47) compared to angiography-guided PCI.
• Reduced risks observed for target lesion revascularization (RR 0.43) and in-stent thrombosis (RR 0.28) with IVUS guidance.
• Beneficial effects of IVUS-guided PCI were consistent across study types, populations, and follow-up durations.

Conclusions:

• IVUS-guided PCI significantly reduces all-cause mortality by approximately 40% in patients with LM CAD compared to conventional angiography guidance.
• IVUS guidance is associated with improved safety outcomes, including reduced cardiac death, revascularization, and in-stent thrombosis.
• The findings support the use of IVUS guidance in LM CAD interventions.