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IVUS-guided PCI superior to angiography guidance for reduction of MACE
In patients who undergo drug-eluting stent implantation for diffuse coronary lesions, the use of IVUS guidance appears superior to angiography guidance for decreasing the risk for MACE.
Researchers performed a meta-analysis of seven randomized clinical trials published from March 2005 to February 2016 that compared IVUS-guided PCI vs. angiography-guided PCI in patients with obstructive CAD undergoing treatment with DES. The trials comprised 3,192 patients.
The cohort had a mean overall lesion length of 35 mm. Patients who underwent IVUS-guided or angiography-guided PCI had comparable baseline diameter stenosis (72% vs. 73%, respectively). The baseline minimum luminal diameter in the IVUS-guided group was slightly larger than in the angiography-guided group (0.92 mm vs. 0.88 mm, respectively).
Postdilation occurred in 63% of the IVUS-guided group compared with 47% of the angiography-guided group (P < .0001). IVUS-guided PCI was linked to a larger postintervention minimum luminal diameter compared with angiography-guided PCI (standardized mean differences, –0.17; 95% CI, –0.29 to –0.05; P = .005).
Compared with angiography guidance, an IVUS-guided procedure was correlated with lower risk for MACE (6.5% vs. 10.3%; OR = 0.6; 95% CI, 0.46-0.77). Similar results were observed in sensitivity analyses (analyses limited to multicenter trials: OR = 0.6; 95% CI, 0.45-0.79; analyses excluding trials with losses to follow-up: OR = 0.55; 95% CI, 0.36-0.84; analyses excluding trials that only implanted first-generation DES: OR = 0.57; 95% CI, 0.41-0.79). Subgroup analysis conducted at 12 and 24 months revealed a similar effect.
IVUS-guided PCI was linked to a significant decrease in target lesion revascularization risk (4.1% vs. 6.6%; OR = 0.6; 95% CI, 0.43-0.84). Compared with angiography guidance, IVUS-guided PCI was associated with lower risk for CV mortality (0.5% vs. 1.2%; OR = 0.46; 95% CI, 0.21-1) and stent thrombosis (0.6% vs. 1.3%; OR = 0.49; 95% CI, 0.24-0.99). IVUS-guided PCI conferred a nonsignificant lower risk for MI vs. angiography-guided PCI (0.8% vs. 1.5%; OR = 0.52; 95% CI, 0.26-1.02).
“In the era of drug-eluting stents, IVUS-guided PCI is superior to angiography-guided PCI in reducing the risk of [MACE],” the researchers wrote. “This is primarily because of reduction in the risk of ischemia-driven target vessel revascularization. The risk of stent thrombosis and [CV] mortality may also be reduced with an IVUS-guided approach.” – by Jennifer Byrne
Disclosure: One researcher reports receiving honoraria from the American College of Cardiology.