Intracoronary Imaging-Guided PCI Linked to Fewer Cardiovascular Events, Suggests Study
USA: Researchers have found in a meta-analysis published in the Journal of the American College of Cardiology that intracoronary imaging-guided percutaneous coronary intervention (PCI) was associated with fewer cardiovascular events compared with angiography-guided PCI. The findings support the potential benefit of using intravascular imaging to optimize stent placement and procedural outcomes.
Intracoronary imaging, including intravascular ultrasound and optical coherence tomography, can provide additional information about coronary lesions and stent deployment that may not be apparent on angiography alone. While current guidelines recommend imaging-guided PCI for selected complex or left main coronary lesions, findings from newer trials have been inconsistent. To reassess the evidence, Sripal Bangalore, MD, Department of Medicine, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, and colleagues conducted an updated meta-analysis.
The investigators searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov through June 3, 2026, identifying randomized controlled trials that compared intracoronary imaging-guided PCI with angiography-guided PCI in the drug-eluting stent era. The analysis incorporated conventional and mixed-treatment comparisons, trial sequential analysis, fragility analysis, and Bayesian methods. Meta-regression was also used to examine whether differences in lesion and procedural characteristics, publication year, or geographic location contributed to variations between studies.
A total of 28 randomized trials involving 24,634 patients were included. Participants had a mean age of 64.8 years, 75.9% were men, and the mean follow-up was 22 months. Compared with angiography-guided procedures, imaging-guided PCI was associated with lower risks across several clinically important outcomes.
Key findings:
- Target lesion failure was reduced by 28% with imaging-guided PCI (RR 0.72).
- Cardiac mortality was 27% lower (RR 0.73).
- Myocardial infarction decreased by 14% (RR 0.86).
- Target vessel revascularization was reduced by 31% (RR 0.69).
- Stent thrombosis was 45% lower (RR 0.55).
- All-cause mortality was reduced by 18% (RR 0.82).
Trial sequential analysis supported at least a 20% reduction across the assessed outcomes, while fragility indices ranged from 9 to 50. Bayesian analysis showed a posterior probability of benefit exceeding 99% for all outcomes. The researchers also found that differences in geographic location and lesion characteristics accounted for much of the variation between trials, particularly for target vessel revascularization.
The authors concluded that, after accounting for differences introduced by recent trials, intracoronary imaging-guided PCI was associated with significantly fewer cardiovascular events than angiography-guided PCI. They noted that geographic differences appeared to be largely related to variations in lesion characteristics and procedural techniques. The findings add to the evidence supporting the use of intravascular imaging to guide PCI and optimize coronary stent implantation.
Reference:
Bangalore, S, Maqsood, M, Zhang, R. et al. Intracoronary Imaging-Guided Percutaneous Coronary Intervention: An Updated Meta-Analysis of Randomized Trials. JACC. null2026, 0 (0). https://doi.org/10.1016/j.jacc.2026.08.008
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