Background
Although intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is associated with a lower risk of major adverse cardiovascular events (MACE) in all comers, the impact of IVUS in complex high-risk PCI continues to be debated.
Methods
We performed a systematic review and meta-analysis of studies that compared the long-term outcomes of IVUS-guided versus angiography-guided PCI in patients with chronic total occlusion (CTO), bifurcation lesions, left main coronary artery (LMCA) lesions and acute myocardial infarction (AMI)
Results
Data from twenty-eight studies, with 49,261 patients (16,951 IVUS-guided and 32,310 angiography-guided), were analyzed. During a median follow up period of 27 months (range 12 to 120 month), use of IVUS was associated with lower incidence of MACE (OR 0.74, 95% CI [0.65, 0.85], P<0.01), all-cause death (OR 0.58, 95% CI [0.49, 0.69],
P<0.01), cardiac death (OR 0.44, 95% CI [0.33, 0.59],
P<0.01), MI (OR 0.72, 95% CI [0.58, 0.89],
P<0.01), TVR (OR 0.73, 95% CI [0.58, 0.92],
P<0.01), TLR (OR 0.69, 95% CI [0.53, 0.91],
P<0.01), composite definite and probable ST (OR 0.54, 95% CI [0.35, 0.83],
P<0.01) and definite ST (OR 0.47, 95% CI [0.26, 0.85],
P=0.01). In LMCA PCI, IVUS was associated with a lower risk of MACE (OR 0.59, 95% CI [0.5, 0.71],
P<0.01), all-cause mortality (OR 0.5, 95% CI [0.43, 0.58],
P<0.01), cardiac death (OR 0.36, 95% CI [0.25, 0.51],
P<0.01), MI (OR 0.69, 95% CI [0.56, 0.85],
P<0.01), composite definite and probable ST (OR 0.58, 95% CI [0.34, 0.99], P=0.05) and TLR (OR 0.45, 95% CI [0.3, 0.67],
P<0.01). In CTO PCI, IVUS was associated with a lower risk of the composite definite and probable ST (OR 0.19, 95% CI [0.05, 0.67],
P=0.01). In bifurcation PCI, IVUS was associated with a lower risk of all-cause mortality (OR 0.58, 95% CI [0.39, 0.85],
P<0.01), cardiac death (OR 0.4, 95% CI [0.18, 0.93],
P=0.03) and TVR (OR 0.47, 95% CI [0.26, 0.85],
P=0.01). IVUS was not associated with better outcomes in acute MI PCI.
Conclusions
IVUS guided complex high-risk PCI was associated with better long-term clinical outcomes compared with angiography.