F-34 | Comparative Analysis of Imaging Modalities for Guiding Complex Coronary Interventions: A Frequentist and Bayesian Network Meta-Analysis of Randomized Controlled Trials

meta-analysis evaluated clinical outcomes of IVI-guided PCI compared to angiography-alone-guided PCI in complex lesion subgroups.Methods: A pairwise random effects meta-analysis of randomized control trials (RCTs) was conducted to compare IVI including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) with angiography alone to guide complex lesions PCI.The outcome of interest was major adverse cardiovascular events (MACE), defined by individual studies to include cardiac death, myocardial infarction and target vessel revascularization.Risk ratios (RRs) were calculated with 95% confidence intervals (CIs).Results: Ten RCTs met inclusion criteria.IVI was associated with significant reductions in MACE compared to angiography alone in multiple lesion subgroups (Figure 1): bifurcations: RR 0.70 (95% CI 0.55-0.89;p0.003); calcified lesions: RR 0.61 (95% CI 0.45-0.83;p0.002); chronic total occlusions: RR 0.56 (95% CI 0.36-0.87;p0.009); left main coronary artery: RR 0.49 (95% CI 0.35-0.68;p<0.001); long lesions: RR 0.63 (95% CI 0.53-0.75;p<0.001); and multivessel disease: RR 0.56 (95% CI 0.45-0.69;p<0.001).No significant difference in MACE was observed for in-stent restenosis (ISR) (RR 0.88; 95% CI 0.59-1.32;p0.548).Conclusions: This meta-analysis demonstrates the superiority of IVIguided PCI over angiography-guided PCI in the spectrum complex lesions.