Intravascular Imaging guided PCI Safer and more effective compared with angiography guidance

The key findings of the study were:

• Twenty-two trials involving 15,964 patients were included, with a mean follow-up duration of 24.7 months.

• Intravascular imaging-guided PCI demonstrated a decreased risk of target lesion failure compared to angiography-guided PCI (RR 0.71, 95% CI 0.63–0.80, p<0.0001).

• This reduction was driven by decreased risks of cardiac death (RR 0.55, 95% CI 0.41–0.75, p=0.0001), TV-MI (RR 0.82, 95% CI 0.68–0.98, p=0.030), and target lesion revascularization (RR 0.72, 95% CI 0.60–0.86, p=0.0002).

• Additionally, intravascular imaging guidance lowered the risks of stent thrombosis (RR 0.52, 95% CI 0.34–0.81, p=0.0036), all myocardial infarction (RR 0.83, 95% CI 0.71–0.99, p=0.033), and all-cause death (RR 0.75, 95% CI 0.60–0.93, p=0.0091).

• Similar outcomes were observed for OCT-guided and intravascular ultrasound-guided PCI.

Intravascular imaging guidance, whether using OCT or intravascular ultrasound, improves both safety and effectiveness of PCI compared to angiography guidance alone. This approach reduces risks of death, myocardial infarction, repeat revascularization, and stent thrombosis, enhancing patient outcomes in coronary stent implantation procedures.

Reference:

Stone, G. W., Christiansen, E. H., Ali, Z. A., Andreasen, L. N., Maehara, A., Ahmad, Y., Landmesser, U., & Holm, N. R. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. Lancet,2024. https://doi.org/10.1016/s0140-6736(23)02454-6