Abstract 4143737: Intravascular Ultrasound Guided Versus Coronary Angiography Guided Complex Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Background: Randomized controlled trials (RCTs) examining the efficacy of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) when compared with coronary angiography (CA)-guided PCI, for complex coronary artery disease, have produced varied findings. We aim to provide conclusive evidence by pooling all RCTs, including the latest IVUS-ACS trial, on the clinical outcomes of IVUS- and CA-guided complex PCI. Methods: MEDLINE, Scopus, and EMBASE were queried from inception till June 2024 for RCTs comparing IVUS and CA in patients undergoing complex PCI for lesions defined as type B2/C according to the American College of Cardiology/American Heart Association guidelines of classification of coronary lesions. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction (MI), or ischemia-driven repeat revascularization. Secondary outcomes were cardiac death, MI, probable/definite stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), and post-procedural minimal lumen diameter (MLD). A random-effects meta-analysis was performed to derive risk ratios (RR) and mean differences (MD) and their corresponding 95% confidence intervals (CI). Results: This meta-analysis included 11 RCTs with a total of 9,828 patients (5,037 in IVUS and 4,791 in CA) with a mean age of 63.8 years. IVUS-guided PCI was associated with significantly lower MACE (RR 0.59; 95% CI 0.51–0.68, p<0.00001) than CA. Similarly, patients in the IVUS group were significantly associated with a reduced risk of cardiac death (RR 0.47; 95% CI 0.29–0.73), MI (RR 0.77; 95% CI 0.60–0.99), TLR (RR 0.58; 95% CI 0.45–0.75), and TVR (RR 0.54; 95% CI 0.41–0.71). IVUS was also significantly associated with a greater MLD (MD 0.09; 95% CI 0.05–0.13) when compared with CA. However, no significant association could be ascertained in all-cause death (RR 0.66; 95% CI 0.40–1.10) and ST (RR 0.59; 95% CI 0.34–1.01). All outcomes reported non-significant heterogeneity and no publication bias was evident upon Egger’s regression (p=0.12). Conclusion: Patients undergoing complex PCI with IVUS showed significantly lower MACE, cardiac death, MI, TLR, and TVR while having a greater MLD when compared with CA-guided PCI.