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Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions: A Meta-Analysis of Randomized
Mohammed A Elbahloul1, Bahaa El Deen Wehbeh2, Ahmed Samy Badran3
1Faculty of Medicine, Kafr El-Shaikh University, El-Shaikh, Egypt. Electronic address: https://twitter.com/MAElbahloul.
Background:
Intravascular imaging (IVI) guidance improves percutaneous coronary intervention (PCI) outcomes, yet recent randomized controlled trials (RCTs) challenged these findings.
Objectives:
This study aimed to evaluate the efficacy and safety of IVI-guided vs angiography-guided PCI in complex coronary lesions, incorporating recent large-scale trials with divergent findings.
Methods:
The authors conducted a meta-analysis of RCTs evaluating IVI-guided vs angiography-guided PCI among patients with complex coronary lesions. The primary outcomes were major adverse cardiovascular events (MACE) and cardiac death. Pooled risk ratios (RRs) with 95% CIs were calculated using frequentist random-effects models and complementary Bayesian analyses. The analysis was complemented by several sensitivity and subgroup analyses.
Results:
Eighteen RCTs enrolling 18,975 patients were included. IVI guidance was associated with significant reductions in MACE (RR: 0.67; 95% CI: 0.55-0.83), cardiac death (RR: 0.72; 95% CI: 0.53-0.97), myocardial infarction (RR: 0.87; 95% CI: 0.76-0.998), clinically driven target lesion revascularization (RR: 0.72; 95% CI: 0.51-0.999), and stent thrombosis (RR: 0.52; 95% CI: 0.35-0.78). A significant geographic interaction was identified for MACE, with benefit predominantly driven by Asian trial populations (Pinteraction < 0.01). In subgroup analysis, patients achieving imaging-defined stent optimization were associated with lower event rates than those who did not (RR: 0.41; 95% CI: 0.26-0.62).
Conclusions:
IVI guidance reduces the risk of adverse events for complex lesions. The benefit was in part driven by achieving imaging-defined stent optimization.