Long Term Clinical Outcomes of Intravascular-Imaging Guided PCI Versus Angiography-Guided PCI In Complex Coronary Lesions: A Systematic Review and Meta-Analysis

Abstract

Abstract Background In this study, we aim to discuss long term clinical outcomes of Intravascular-imaging guided PCI versus angiography-guided PCI in complex coronary lesions over a mean period of two years. Methods A systematic search and meta-analysis were conducted to assess the efficacy of using Intravascular Ultrasound or Optical Coherence Tomography guidance in coronary artery stenting compared to angiography. Outcome measures such as Target Lesion Revascularization, Major Adverse Cardiovascular Events, Target Vessel Revascularization, Stent Thrombosis, and Myocardial Infarction were analyzed. Risk ratios were used as the primary outcome measure. Publication bias was evaluated using a modified Cochrane Collaboration's risk of bias tool for Randomized Controlled Trials. Results Eleven randomized control trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2% vs 5.6%, RR 0.61, 0.48–0.77, P < 0.0001, I2 = 0%, Heterogeneity p value = 0.98) showed that the results were in favor of imaging guided PCI. For secondary outcomes, the risk was significantly low in Image guide PCI compared to angiography (4.1% vs 7.2%, RR 00.61, 00.48–0.77, P < 0.0001, I2 = 0%,Pheterogeneity = 0.99) for TVR, (1.3% vs 2.3%, RR 0.57, 0.39–0.83, P = 0.003, I2 = 0%, Pheterogeneity = 0.92) for cardiac death, (6.9% vs 11.3%, RR 0.63, 0.54–0.73, P < 0.00001, I2 = 0%, Pheterogeneity = 0.80) for MACE (Major Adverse Cardiac Events), (0.4% vs 1.3%, RR 0.40, 0.21–0.75, P = 0.004, I2 = 0%, Pheterogeneity = 0.70) for ST and (2.8% vs 3.6%, RR 0.76, 0.58–0.99, P = 0.04, I2 = 0%, Pheterogeneity = 0.63) for MI. Conclusion Intravascular Imaging Guided PCI is significantly more effective than Angiography Guided PCI in reducing the risk of TLR, TVR, Cardiac Death, MACE, ST.