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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

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Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review

Safi U Khan1, Siddharth Agarwal2, Hassaan B Arshad1

  • 1Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.

BMJ (Clinical Research Ed.)
|November 16, 2023
PubMed

Insights

Intravascular imaging guidance for percutaneous coronary intervention significantly reduces cardiac death and adverse cardiovascular events in patients with coronary artery disease. These benefits increase with higher patient baseline risk, showing substantial absolute risk reductions.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Percutaneous coronary intervention (PCI) is a cornerstone in managing coronary artery disease (CAD).
  • Optimal PCI guidance remains crucial for improving patient outcomes.
  • Intravascular imaging (IVI) offers detailed vessel visualization beyond standard angiography.

Approach:

  • Systematic review and meta-analysis of 20 randomized controlled trials (RCTs) involving 11,698 patients.
  • Compared IVI-guided PCI (using intravascular ultrasonography or optical coherence tomography) with angiography-guided PCI.
  • Utilized random-effects meta-analysis and GRADE methodology to assess evidence certainty and absolute risk differences based on SYNTAX risk categories.

Key Points:

  • IVI-guided PCI significantly reduced risks of cardiac death (RR 0.53), myocardial infarction (RR 0.81), stent thrombosis (RR 0.44), and revascularization events.
  • High certainty evidence demonstrated absolute risk reductions per 1000 people: 23-64 fewer cardiac deaths, 15-19 fewer MIs, 9-13 fewer stent thromboses, 28-38 fewer TVRs, and 35-48 fewer TLRs.
  • Absolute benefits were proportional to baseline cardiovascular risk, highlighting the importance of IVI in higher-risk patients.

Conclusions:

  • IVI-guided PCI is superior to angiography-guided PCI for improving cardiovascular outcomes in CAD patients.
  • The absolute treatment effect of IVI-guided PCI is significantly influenced by patient baseline risk, particularly in those with complex coronary artery disease.
  • These findings support the routine use of intravascular imaging to optimize PCI strategy and reduce adverse events.
Abstract

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