Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Control Trials

Background: Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) allows better assessment of coronary artery lesion characteristics than angiography alone. This systematic review and meta-analysis aimed to comprehensively synthesize the available evidence regarding the efficacy of IVUS guidance compared to angiography-guided PCI.

Methods: A comprehensive literature search of major bibliographic databases from inception until April 2024 was conducted to identify randomized control trials (RCTs) comparing IVUS-guided PCI versus angiography-guided PCI. Risk ratios (RR) with their corresponding 95% confidence intervals (CI) were pooled using the random-effects model, with a p < 0.05 considered statistically significant.

Results: Fifteen RCTs were included with 9354 patients undergoing PCI. IVUS-guided PCI was associated with a lower risk of cardiac death [RR 0.49, 95% CI 0.33 to 0.72], major adverse cardiovascular events (MACE) [RR 0.64, 95% CI 0.51 to 0.80], myocardial infarction [RR 0.74, 95% CI 0.59 to 0.94], stent thrombosis [RR 0.48, 95% CI 0.29 to 0.81], target lesion revascularization [RR 0.60, 95% CI 0.48 to 0.75], and target vessel revascularization [RR 0.54, 95% CI 0.43 to 0.69] compared to angiography-guided PCI. IVUS-guided PCI was associated with a nonsignificant trend toward a reduced risk of all-cause mortality [RR 0.82, 95% CI 0.58 to 1.01]. Meta-regression showed a nonsignificant moderating effect of the duration of follow-up, age of patients, diabetes mellitus, and acute coronary syndrome presentation of patients on pooled outcomes.

Conclusion: IVUS-guided PCI reduced cardiac death, MACE, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared to angiography-guided PCI.