Intravascular Ultrasound Imaging–Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis

Abstract

Background Intravascular ultrasound ( IVUS ) guidance during percutaneous coronary intervention ( PCI ) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of PCI . However, the long‐term beneficial effect of IVUS over PCI guided by coronary angiography ( CA ) alone remains under question. We sought to investigate the outcomes of IVUS ‐guided compared with CA ‐guided PCI . Methods and Results We performed a comprehensive search of PubMed, Medline, and Cochrane Central Register, looking for randomized controlled trials and observational studies that compared PCI outcomes of IVUS with CA . Data were aggregated for the primary outcome measure using the random‐effects model as pooled risk ratio ( RR ). The primary outcomes were the rate of cardiovascular death, need for target lesion revascularization, occurrence of myocardial infarction, and rate of stent thrombosis. A total of 19 studies met the inclusion criteria, comprising 27 610 patients divided into IVUS (n=11 513) and CA (n=16 097). Compared with standard CA ‐guided PCI , we found that the risks of cardiovascular death ( RR , 0.63; 95% CI , 0.54–0.73), myocardial infarction ( RR , 0.71; 95% CI , 0.58–0.86), target lesion revascularization ( RR , 0.81; 95% CI , 0.70–0.94), and stent thrombosis ( RR , 0.57; 95% CI , 0.41–0.79) were all significantly lower using IVUS guidance. Conclusions Compared with standard CA ‐guided PCI , the use of IVUS imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis.