Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials
Background Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study‐level meta‐analysis comparing intravascular imaging to angiography to guide P...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031111 |
| _version_ | 1827342147521609728 |
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| author | Jayakumar Sreenivasan Rohin K. Reddy Yasser Jamil Aaqib Malik Daniel Chamie James P. Howard Michael G. Nanna Gary S. Mintz Akiko Maehara Ziad A. Ali Jeffrey W. Moses Shao‐Liang Chen Alaide Chieffo Antonio Colombo Martin B. Leon Alexandra J. Lansky Yousif Ahmad |
| author_facet | Jayakumar Sreenivasan Rohin K. Reddy Yasser Jamil Aaqib Malik Daniel Chamie James P. Howard Michael G. Nanna Gary S. Mintz Akiko Maehara Ziad A. Ali Jeffrey W. Moses Shao‐Liang Chen Alaide Chieffo Antonio Colombo Martin B. Leon Alexandra J. Lansky Yousif Ahmad |
| author_sort | Jayakumar Sreenivasan |
| collection | DOAJ |
| description | Background Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study‐level meta‐analysis comparing intravascular imaging to angiography to guide PCI was performed. This study aimed to evaluate the clinical outcomes of intravascular imaging–guided PCI compared with angiography‐guided PCI. Methods and Results A random‐effects meta‐analysis was performed on the basis of the intention‐to‐treat principle. The primary outcomes were major adverse cardiac events, cardiac death, and all‐cause death. Mixed‐effects meta‐regression was performed to investigate the impact of complex PCI on the primary outcomes. A total of 16 trials with 7814 patients were included. The weighted mean follow‐up duration was 28.8 months. Intravascular imaging led to a lower risk of major adverse cardiac events (relative risk [RR], 0.67 [95% CI, 0.55–0.82]; P<0.001), cardiac death (RR, 0.49 [95% CI, 0.34–0.71]; P<0.001), stent thrombosis (RR, 0.63 [95% CI, 0.40–0.99]; P=0.046), target‐lesion revascularization (RR, 0.67 [95% CI, 0.49–0.91]; P=0.01), and target‐vessel revascularization (RR, 0.60 [95% CI, 0.45–0.80]; P<0.001). In complex lesion subsets, the point estimate for imaging‐guided PCI compared with angiography‐guided PCI for all‐cause death was a RR of 0.75 (95% CI, 0.55–1.02; P=0.07). Conclusions In patients undergoing PCI, intravascular imaging is associated with reductions in major adverse cardiac events, cardiac death, stent thrombosis, target‐lesion revascularization, and target‐vessel revascularization. The magnitude of benefit is large and consistent across all included studies. There may also be benefits in all‐cause death, particularly in complex lesion subsets. These results support the use of intravascular imaging as standard of care and updates of clinical guidelines. |
| first_indexed | 2024-03-07T22:02:29Z |
| format | Article |
| id | doaj.art-ada1b6a475034b98888d54fc69e8b103 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:29Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ada1b6a475034b98888d54fc69e8b1032024-02-24T04:04:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-01-0113210.1161/JAHA.123.031111Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized TrialsJayakumar Sreenivasan0Rohin K. Reddy1Yasser Jamil2Aaqib Malik3Daniel Chamie4James P. Howard5Michael G. Nanna6Gary S. Mintz7Akiko Maehara8Ziad A. Ali9Jeffrey W. Moses10Shao‐Liang Chen11Alaide Chieffo12Antonio Colombo13Martin B. Leon14Alexandra J. Lansky15Yousif Ahmad16Section of Cardiovascular Medicine Yale University School of Medicine New Haven CT USANational Heart and Lung Institute Imperial College London London United KingdomSection of Cardiovascular Medicine Yale University School of Medicine New Haven CT USADepartment of Cardiology Westchester Medical Center, New York Medical College Valhalla NY USASection of Cardiovascular Medicine Yale University School of Medicine New Haven CT USANational Heart and Lung Institute Imperial College London London United KingdomSection of Cardiovascular Medicine Yale University School of Medicine New Haven CT USACardiovascular Research Foundation New York NY USACardiovascular Research Foundation New York NY USACardiovascular Research Foundation New York NY USACardiovascular Research Foundation New York NY USANanjing First Hospital Nanjing Medical University Nanjing ChinaVita Salute San Raffaele University Milan ItalyHumanitas IRCCS Milan ItalyCardiovascular Research Foundation New York NY USASection of Cardiovascular Medicine Yale University School of Medicine New Haven CT USASection of Cardiovascular Medicine Yale University School of Medicine New Haven CT USABackground Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study‐level meta‐analysis comparing intravascular imaging to angiography to guide PCI was performed. This study aimed to evaluate the clinical outcomes of intravascular imaging–guided PCI compared with angiography‐guided PCI. Methods and Results A random‐effects meta‐analysis was performed on the basis of the intention‐to‐treat principle. The primary outcomes were major adverse cardiac events, cardiac death, and all‐cause death. Mixed‐effects meta‐regression was performed to investigate the impact of complex PCI on the primary outcomes. A total of 16 trials with 7814 patients were included. The weighted mean follow‐up duration was 28.8 months. Intravascular imaging led to a lower risk of major adverse cardiac events (relative risk [RR], 0.67 [95% CI, 0.55–0.82]; P<0.001), cardiac death (RR, 0.49 [95% CI, 0.34–0.71]; P<0.001), stent thrombosis (RR, 0.63 [95% CI, 0.40–0.99]; P=0.046), target‐lesion revascularization (RR, 0.67 [95% CI, 0.49–0.91]; P=0.01), and target‐vessel revascularization (RR, 0.60 [95% CI, 0.45–0.80]; P<0.001). In complex lesion subsets, the point estimate for imaging‐guided PCI compared with angiography‐guided PCI for all‐cause death was a RR of 0.75 (95% CI, 0.55–1.02; P=0.07). Conclusions In patients undergoing PCI, intravascular imaging is associated with reductions in major adverse cardiac events, cardiac death, stent thrombosis, target‐lesion revascularization, and target‐vessel revascularization. The magnitude of benefit is large and consistent across all included studies. There may also be benefits in all‐cause death, particularly in complex lesion subsets. These results support the use of intravascular imaging as standard of care and updates of clinical guidelines.https://www.ahajournals.org/doi/10.1161/JAHA.123.031111intravascular ultrasoundmeta‐analysisoptical coherence tomographypercutaneous coronary intervention |
| spellingShingle | Jayakumar Sreenivasan Rohin K. Reddy Yasser Jamil Aaqib Malik Daniel Chamie James P. Howard Michael G. Nanna Gary S. Mintz Akiko Maehara Ziad A. Ali Jeffrey W. Moses Shao‐Liang Chen Alaide Chieffo Antonio Colombo Martin B. Leon Alexandra J. Lansky Yousif Ahmad Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease intravascular ultrasound meta‐analysis optical coherence tomography percutaneous coronary intervention |
| title | Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials |
| title_full | Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials |
| title_fullStr | Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials |
| title_full_unstemmed | Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials |
| title_short | Intravascular Imaging–Guided Versus Angiography‐Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis of Randomized Trials |
| title_sort | intravascular imaging guided versus angiography guided percutaneous coronary intervention a systematic review and meta analysis of randomized trials |
| topic | intravascular ultrasound meta‐analysis optical coherence tomography percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031111 |
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