Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions

BACKGROUND: Intravascular imaging (IVI) guidance improves percutaneous coronary intervention (PCI) outcomes, yet recent randomized controlled trials (RCTs) challenged these findings. OBJECTIVES: This study aimed to evaluate the efficacy and safety of IVI-guided vs angiography-guided PCI in complex coronary lesions, incorporating recent large-scale trials with divergent findings. METHODS: The authors conducted a meta-analysis of RCTs evaluating IVI-guided vs angiography-guided PCI among patients with complex coronary lesions. The primary outcomes were major adverse cardiovascular events (MACE) and cardiac death. Pooled risk ratios (RRs) with 95% CIs were calculated using frequentist random-effects models and complementary Bayesian analyses. The analysis was complemented by several sensitivity and subgroup analyses. RESULTS: < 0.01). In subgroup analysis, patients achieving imaging-defined stent optimization were associated with lower event rates than those who did not (RR: 0.41; 95% CI: 0.26-0.62). CONCLUSIONS: IVI guidance reduces the risk of adverse events for complex lesions. The benefit was in part driven by achieving imaging-defined stent optimization.