Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a systematic review and bayesian network meta-analysis of randomized controlled trials

• Published in: BMC cardiovascular disorders 2024-09, Vol.24 (1), p.483-20, Article 483
• Main Authors: Amin, Ahmed Mazen, Khlidj, Yehya, Abuelazm, Mohamed, Sayed, Ahmed, Khan, Ubaid, Elewidi, Mariam Mahmoud, Tanashat, Mohammad, Elharti, Hesham, Ellabban, Mohamed Hatem, Alassiri, Abdullah K, Alsaed, Mohamad, Abdelazeem, Basel, Kawsara, Akram
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Angioplasty; Bayes Theorem; Bayesian analysis; Bias; Cardiovascular diseases; Care and treatment; Clinical trials; Computer-assisted surgery; Coronary Angiography; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary heart disease; Coronary Vessels - diagnostic imaging; Female; Heart attacks; Humans; Implants; Intervention; Intravascular ultrasound; Male; Medical imaging; Meta-analysis; Methods; Middle Aged; Mortality; Myocardial infarction; Network Meta-Analysis; Optical coherence tomography; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Predictive Value of Tests; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Statistical analysis; Stenosis; Systematic Review; Thrombosis; Tomography, Optical Coherence; Transluminal angioplasty; Treatment Outcome; Ultrasonography, Interventional; Vascularization
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-04105-5

Percutaneous coronary intervention (PCI) has become one of the most commonly performed interventional life-saving procedures worldwide. Intravascular Imaging (intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) have initially evolved to guide PCI compared with angiography. However, this technology is not universally employed in all PCI procedures, and there is ongoing controversy regarding its additional benefits to patient outcomes. We aim to estimate the efficacy and safety of imaging modalities during PCI, allowing pre-, per, and post-intervention assessment of coronary vascularization. A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs), which were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used R, version 4.2.0. Effect sizes will be presented as odds ratios with accompanying 95% credible intervals. CRD42024507821. Our study, encompassing 36 RCTs with a total of 17,572 patients, revelead that compared to conventional angiography, IVUS significantly reduced the risk of major adverse cardiovascular events (MACE) (OR: 0.71 [95% CrI: 0.56 to 0.87]) but not OCT (OR: 0.91 [95% CrI: 0.62 to 1.39]), IVUS and OCT significantly reduced the risk of cardiac death (OR: 0.50 [95% CrI: 0.33 to 0.76]) and (OR: 0.55 [95% CrI: 0.31 to 0.98]), respectively, IVUS significantly reduced the risk of target vessel-related revascularization (OR: 0.60 [95% CrI: 0.48 to 0.75]) but not OCT (OR: 0.86 [95% CrI: 0.60 to 1.19]), IVUS and OCT significantly reduced the risk of stent thrombosis (OR: 0.50 [95% CrI: 0.28 to 0.92]) and (OR: 0.48 [95% CrI: 0.22 to 0.98]), respectively, IVUS significantly reduced the risk of re-stenosis (OR: 0.65 [95% CrI: 0.46 to 0.88]) but not OCT (OR: 0.55 [95% CrI: 0.15 to 1.99]), neither IVUS (OR: 0.97 [95% CrI: 0.71 to 1.38]) nor OCT (OR: 0.75 [95% CrI: 0.49 to 1.22]) were associated with statistically significant reductions in all-cause mortality, neither IVUS (OR: 0.70 [95% CrI: 0.45 to 1.32]) nor OCT (OR: 0.81 [95% CrI: 0.47 to 1.59]) were associated with statistically significant reductions in target vessel failure, neither IVUS (OR: 0.88 [95% CrI: 0.43 to 2.44]) nor OCT (OR: 0.81 [95% CrI: 0.37 to 2.04]) were associated with statistically significant reductions in target lesion failure, and neither IVUS (OR: 0.82 [95% CrI: 0.60 to 1.06]) nor OCT (OR: 0.84 [95% CrI: 0.59 to 1.19]) were associated with statistically significant reductions in myocard