Clinical Outcomes Following Hemodynamic Parameter or Intravascular Imaging-Guided Percutaneous Coronary Intervention
Meng-Jin Hu1, Jiang-Shan Tan1, Lu Yin1
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces major adverse cardiovascular events compared to coronary angiography (CAG). Hemodynamic guidance (FFR/QFR) also lowers stroke risk, offering improved outcomes in the drug-eluting stent era.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary angiography (CAG) is standard for percutaneous coronary interventions (PCI).
- Intracoronary imaging (IVUS, OCT) and hemodynamic assessment (FFR) offer advantages over CAG.
- This study evaluates PCI guidance modalities in the drug-eluting stent (DES) era.
Approach:
- Network meta-analysis of 28 randomized trials.
- Included 11,860 patients undergoing PCI with different guidance modalities.
- Calculated odds ratios (OR) with 95% credible intervals (CrI).
Key Points:
- IVUS-guided PCI significantly reduced major adverse cardiovascular events (MACE), cardiovascular death, and target vessel revascularization (TVR/TLR) versus CAG.
- A trend towards decreased stent thrombosis was observed with IVUS.
- FFR/QFR-guided PCI significantly reduced stroke risk compared to CAG, IVUS, and OCT/OFDI.
Conclusions:
- IVUS-guided PCI improves outcomes by reducing MACE, cardiovascular death, and TVR/TLR in the DES era.
- FFR/QFR guidance offers a significant reduction in stroke risk.
- While MI, death, stent thrombosis, and revascularization risks were similar across modalities, IVUS and FFR/QFR show specific benefits.
Background:
Coronary angiography (CAG) is the standard imaging modality for guiding percutaneous coronary interventions (PCI). Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and hemodynamic parameter like fractional flow reserve (FFR) can overcome some limitations of CAG.
Objective:
We sought to explore the clinical outcomes of different PCI guidance modalities in the era of drug-eluting stent (DES).
Methods:
A network meta-analysis of 28 randomized trials and 11,860 patients undergoing different modalities-guided PCI in the era of DES was performed. Odds ratio (OR) with 95% credible interval (CrI) were calculated.
Results:
In comparison with CAG, IVUS was associated with a significant reduction in major adverse cardiovascular events (MACE, OR: 0.60; 95% CrI: 0.46-0.79), cardiovascular death (OR: 0.46; 95% CrI: 0.20-0.94), target vessel/lesion revascularization (TVR/TLR, OR: 0.55; 95% CrI: 0.41-0.74), and a trend toward decreased risk of stent thrombosis (OR: 0.44; 95% CrI: 0.17 to 1.00). FFR/quantitative flow ratio (QFR) could significantly reduce stroke compared with CAG, IVUS, and OCT/optical frequency domain imaging (OFDI). However, myocardial infarction (MI), all-cause death, stent thrombosis, and any revascularization presented similar risks for different PCI guidance modalities.
Conclusion:
In the era of DES, IVUS led to lower risks of MACE than CAG, which was mainly due to lower risks of cardiovascular death and TVR/TLR. A trend toward decreased risk of stent thrombosis was also observed with IVUS. Hemodynamic parameter (FFR/QFR)-guided PCI could significantly reduce the stroke risk compared with CAG, IVUS, and OCT/OFDI.
Systematic Review Registration:
[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021291442].
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