The Outcomes of Stent Implantation via Intravascular Imaging-Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention:A Systemic Review and Meta-Analysis of 18 studies.

Darmoch, Fahed

The Outcomes of Stent Implantation via Intravascular Imaging-Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention:A Systemic Review and Meta-Analysis of 18 studies.

Wednesday, May 22, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Fahed Darmoch, M.D. , St. Vincent charity medical center , Boston, MA

M. Chadi Alraies, M.D. , Detroit Medical Center Heart Hospital, Detroit, MI

Yasser Al-khadra, M.D. , Cleveland Clinic Foundation, Cleveland, OH

Homam Moussa Pacha , Medstar Institute, Washington Hospital Center, Washington, DC

Mohamad Soud, M.D. , Washingtom Hospital Center, Washigton, DC

Duane S. Pinto, M.D., FSCAI , Beth Israel Deaconess Medical Center, Boston, MA

Eric A. Osborn, M.D., Ph.D., FSCAI , Beth Israel Deaconess Medical Center, Boston, MA

Background
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) offers detailed tomographic images of coronary vessels and stents. The advantages of IVUS over coronary angiography (CA) PCI remain controversial. We sought to investigate the outcomes of IVUS-guided PCI compared with angiography-guided PCI

Methods
A comprehensive search randomized controlled trails (RCT) and observational studies comparing PCI outcomes guided by IVUS or CA. Using a random-effects model, data was pooled for the primary outcome measures, which included cardiovascular death, target lesion revascularization, myocardial infarction, and stent thrombosis.

Results
A total of 18 studies included 12,946 patients divided into IVUS (n=6,571) vs. CA(n=6,571). When comparing IVUS to CA PCI guidance we found that IVUS-guided PCI was associated with significant reductions in the risk of cardiovascular death (Risk Ratio[RR]: 0.53; 95% Confidence Interval[CI]: 0.41-0.68), myocardial infarction (RR: 0.63; 95% [CI]: 0.51-.78), target lesion revascularization (RR: 0.82; 95% [CI]: 0.73-0.94) and stent thrombosis (RR: 0.63; 95% [CI]: 0.51-.076). Statistical heterogeneity in cardiovascular death and myocardial infarction were (heterogeneity chi-square = 25.84, I² = 34%, p = 0.398), but there was higher heterogeneity in target lesion revascularization and stent thrombosis (heterogeneity chi-square = 47.29, I² = 66 %, p = 0.004; heterogeneity chi-square = 31.03, I² = 52%, p <0.001, respectively).

Conclusions
Compared with CA, we found that the use of IVUS-guidance for PCI optimization was associated with a significant reduction in cardiovascular events.