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The Clinical Effects of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients with Chronic

Zhaoshuang Zhong1, Long Zhao1, Kaiming Chen2

  • 1Department of Respiratory, Central Hospital, Shenyang Medical College, Shenyang, China.

Cardiology Research and Practice
|March 28, 2022
PubMed

Insights

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) does not significantly reduce major adverse cardiac events in patients with chronic total occlusion (CTO) lesions. Further high-quality trials are needed to confirm these findings.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • The clinical efficacy of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions is not well-established.
  • Angiography-guided PCI is the current standard, but its limitations in complex lesions like CTOs warrant investigation into alternative guidance methods.

Purpose of the Study:

  • To conduct a meta-analysis comparing the clinical outcomes of IVUS-guided CTO-PCI versus angiography-guided CTO-PCI.
  • To evaluate the impact of IVUS guidance on major adverse cardiac events (MACE) and other key clinical endpoints in CTO interventions.

Main Methods:

  • A systematic literature search was performed across major databases (PubMed, Embase, Cochrane Library, ISI Web of Science) up to November 2021.
  • Five studies comprising 2320 patients were included, comparing IVUS-guided PCI with angiography-guided PCI for CTO lesions.
  • Key endpoints analyzed included MACE, cardiac death, all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR).

Main Results:

  • The meta-analysis found no statistically significant reduction in MACE (RR 0.929, P=0.457) with IVUS-guided PCI compared to angiography-guided PCI.
  • Similarly, no significant differences were observed for cardiac death (RR 0.574, P=0.096), all-cause death (RR 0.677, P=0.158), MI (RR 0.836, P=0.482), or TVR (RR 0.929, P=0.648).
  • The heterogeneity among studies for MACE and MI was low to moderate (I²=27.4% and 46.7%, respectively).

Conclusions:

  • IVUS-guided PCI does not offer significant advantages over angiography-guided PCI in terms of MACE and other major adverse cardiac events for patients with CTO lesions.
  • The current evidence suggests that IVUS guidance may not improve procedural outcomes in this specific patient population.
  • Further high-quality randomized controlled trials (RCTs) are recommended to definitively ascertain the role of IVUS in CTO interventions, considering the limitations of the existing studies.
Abstract

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