Outcomes of Intravascular Ultrasound Guided-Percutaneous Coronary Intervention versus Conventional Percutaneous Coronary Intervention: A Meta-analysis of Randomized Controlled Trials

Abstract

BACKGROUND: Coronary angiography has been the standard test in evaluating coronary artery disease. However, this procedure has its limitations in estimating disease severity. Intravascular ultrasound (IVUS) promises to be a more sensitive tool for correct assessment of true lumen dimensions and architecture, as well as atherosclerotic plaque burden and vessel wall abnormalities. The use of IVUS during percutaneous coronary intervention (PCI) may therefore optimize the results of PCI, particularly of stent implantation. In addition, IVUS provides the operator with better information on real vessel size, which facilitates device selection. The objective of this study was to compare the outcomes of patients who underwent IVUS guided PCI versus conventional PCI after 12 months based on target lesion revascularization, death and all-cause mortality, myocardial infarction and any major adverse coronary event (MACE). METHODS: This was a meta-analysis that included published randomized controlled trials that compared the outcomes of patients who underwent IVUS guided-PCI versus conventional PCI. Included trials were searched from electronic databases, such as Pubmed, ClinicalTrials.gov, and HighWire. Results of identified studies that reported the outcomes of on target lesion revascularization, death and all-cause mortality, myocardial infarction (MI) and any major adverse cardiac event (MACE) were tabulated and subjected to meta-analysis. RESULTS: A total of seven randomized clinical trials were included in this meta-analysis, including a total of 6,370 patients. The primary endpoint of target lesion revascularization at 12 months was significantly lower in patients who underwent IVUS-guided PCI (RR 0.66; 95% CI 0.55, 0.79; p<0.001) compared with conventional PCI. Death and all-cause mortality were higher in the conventional PCI group compared with the IVUS-guided PCI group (RR 0.78; 95% CI 0.62, 0.98; p=0.037). The incidence of myocardial infarction and any MACE showed no significant difference between the two groups. CONCLUSION: This study showed that IVUS-guided PCI resulted in lower target lesion revascularization and mortality rate at 12 months when compared with conventional PCI. Both groups resulted in similar outcome in terms of MI and any MACE at 12 months.