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Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and
Jayakumar Sreenivasan1, Rohin K Reddy2, Yasser Jamil1
1Section of Cardiovascular Medicine Yale University School of Medicine New Haven CT USA.
Journal of the American Heart Association
|January 12, 2024
Summary
Intravascular imaging significantly reduces major adverse cardiac events and cardiac death after percutaneous coronary intervention (PCI). These findings support its use as a standard of care in PCI procedures.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical imaging
Background:
- Percutaneous coronary intervention (PCI) is a common procedure, but optimal guidance remains debated.
- Intravascular imaging (IVI) offers detailed views of coronary anatomy, potentially improving PCI outcomes compared to standard angiography.
- Despite evidence, IVI adoption in PCI guidance is suboptimal.
Approach:
- An updated, study-level meta-analysis was conducted, pooling data from 16 randomized trials involving 7814 patients undergoing PCI.
- The analysis followed an intention-to-treat principle, assessing major adverse cardiac events (MACE), cardiac death, and all-cause death as primary outcomes.
- Mixed-effects meta-regression explored the influence of complex PCI on clinical outcomes.
Key Points:
- Intravascular imaging guidance significantly lowered the risk of MACE (RR 0.67), cardiac death (RR 0.49), stent thrombosis (RR 0.63), target-lesion revascularization (RR 0.67), and target-vessel revascularization (RR 0.60).
- Benefits were consistent across all included studies, indicating a large and reliable effect.
- While not statistically significant (P=0.07), a trend towards reduced all-cause mortality was observed in complex PCI subsets.
Conclusions:
- Intravascular imaging guidance in PCI is associated with significant reductions in key adverse cardiovascular events and mortality.
- The benefits are substantial and consistent, supporting its integration into routine clinical practice.
- These findings advocate for the routine use of intravascular imaging as a standard of care and for guideline updates.
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