The Use of Intravascular Imaging to Guide PCI Reduces Cardiovascular Death Risk, Compared to Angiography

Intravascular imaging, which includes ultrasound intravascular (IVUS) and optical coherence tomography (OCT), shows live details that better characterize post stenting plaque, anatomy and outcomes.  The already familiar limitations of the angiography has lead us to think that IVUS and OCT could improve clinical outcomes; however, we should still find the evidence to support this claim.

To shed some light on this matter, researchers carried out this meta-analyzis of well-adjusted randomized and observational studies comparing angiography guided against OCT or IVUS guided PCI with stent.

Read also: “The use of IVUS in unprotected left main PCI associated to better outcomes, compared to angiography guided PCI”.

It included 31 studies and 17882 patients, which makes this study one of the largest ever done so far.

Compared to conventional angiography, the use of IVUS significantly reduced all events analyzed, including: all-cause mortality (OR 0.74, CI 95% 0.58 to 0.98), acute myocardial infarction (OR 0.72, CI 95% 0.52 to 0.93), target vessel revascularization (OR: 0.74, CI 95% 0.58 to 0.9) and stent thrombosis (OR 0.42, CI 95% 0.2 to 0.72).

Read also: “FFR, IVUS and OCT in Chronic Coronary Syndromes”.

Intravascular imaging guided PCI (be it IVUS or OCT) was associated to significant combined events rate (OR 0.79, CI 95% 0.67 to 0.91 for IVUS and OR 0.68, CI 95% 0.49 to 0.97 for OCT). Cardiovascular death saw similar outcomes.

There were no clinical differences in terms of efficacy between IVUS and OCT across all end points.

Read also: “Critical Lower Limb Ischemia Should Be Taken into Account in TAVR”.

IVUS effect was neutralized only when looking at all-cause mortality in randomized studies.

Conclusion

The use of intravascular imaging (be it IVUS or OCT) to guide PCI reduces cardiovascular death and all adverse events, compared against conventional angioplasty.

Original title: Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention with Stent Implantation. A Systematic Review and Bayesian Network Meta-Analysis of 31 Studies and 17,882 Patients.

Reference: Sergio Buccheri et al. J Am Coll Cardiol Intv 2017, article in press.

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