Short- and Long-Term Prognosis of Intravascular Ultrasound-Versus Angiography-Guided Percutaneous Coronary Intervention: A Meta-Analysis Involving 24,783 Patients.

Qun Zhang,Shukun Sun,Ruijuan Lv,Shujian Wei,Bailu Wang,Yu Han,Joseph Dens

doi:10.1155/2021/6082581

Abstract

Background Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) has potential benefits. This meta-analysis aimed to explore whether IVUS-guided PCI had better short- and long-term prognoses than angiography-guided PCI. Methods We retrieved studies from PubMed, Embase, and Cochrane Library. Clinical trials including retrospective and randomized controlled trials (RCTs) that compared IVUS-guided PCI with angiography-guided PCI were included. The patients were followed up after operation at 30 days, 1 year, 2 years, and 3 years. The clinical outcomes were target lesion revascularization (TLR), target vessel revascularization (TVR), and MACEs, including stent thrombosis (ST), myocardial infarction (MI), cardiac death, and all-cause death. The study population included patients with MI, coronary bifurcation lesions, short or long lesions, and unprotected left main coronary artery stenosis (ULMCA). The quality of retrospective trials was evaluated using the Newcastle–Ottawa Scale, and the quality of randomized controlled trials was evaluated using the Jadad score. A total of 20 clinical trials met the criteria. Three trials were randomized controlled trials, while 17 were retrospective trials. Results A total of 24,783 patients were included. In observational trials, the OR of MACEs was 0.49 (95% CI: 0.38–0.62) in 30 days, 0.65 (95% CI: 0.58–0.73) in one year, 0.51 (95% CI: 0.36–0.71) in two years, and 0.45 (95% CI: 0.31–0.65) in three years. In patients with long coronary lesions, the OR of MACEs in 1 year was 0.64 (95% CI: 0.28–1.50). In patients with left main artery disease, the OR of MACEs in 3 years was 0.42 (95% CI: 0.26–0.67). Compared with angiography-guided PCI, IVUS-guided PCI was associated with a lower incidence of MACEs during the same following period. Conclusion Compared with angiography-guided PCI, IVUS-guided PCI has better performance in reducing the occurrence of MACEs.

Highlights

Coronary artery disease (CAD) due to blockage or stenosis of the coronary arteries is a major cause of morbidity and mortality worldwide [1]
At the 2-year follow-up, the Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) was associated with a lower incidence of stent thrombosis (ST) (OR: 0.28, 95% confidence interval (CI): 0.10–0.80, P 0.02, I2 0%), myocardial infarction (MI) (OR: 0.57, 95% CI: 0.37–0.87, P 0.010, I2 72%), and major cardiovascular adverse events (MACEs) (OR: 0.51, 95% CI: 0.36–0.71; P < 0.001, I2 0%) (Figure 4)
At the 3-year follow-up, the IVUS-guided PCI was associated with a lower incidence of MI (OR: 0.64, 95% CI: 0.49–0.83, P 0.0009, I2 5%), cardiac death (OR: 0.41, 95% CI: 0.24–0.69, P 0.0009, I2 55%), all-cause death (OR: 0.54, 95% CI: 0.36–0.81, P 0.003, I2 53%), and MACEs

Summary

Introduction

Coronary artery disease (CAD) due to blockage or stenosis of the coronary arteries is a major cause of morbidity and mortality worldwide [1]. Coronary revascularization, including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), is the most effective treatment for CAD. PCI-related complications, including in-stent restenosis and stent thrombosis, limit its advantages. Improving the procedural technologies of PCI is critical to the clinical outcomes of patients with CAD [3]. The clinical application of IVUS provides more accurate details of coronary lesions by comprehensively evaluating the structure of the coronary arteries [4, 5]. Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) has potential benefits.

Objectives

Methods

Conclusion