Intravascular Ultrasound Imaging–Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Intravascular ultrasound ( <jats:styled-content style="fixed-case">IVUS</jats:styled-content> ) guidance during percutaneous coronary intervention ( <jats:styled-content style="fixed-case">PCI</jats:styled-content> ) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of <jats:styled-content style="fixed-case">PCI</jats:styled-content> . However, the long‐term beneficial effect of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> over <jats:styled-content style="fixed-case">PCI</jats:styled-content> guided by coronary angiography ( <jats:styled-content style="fixed-case">CA</jats:styled-content> ) alone remains under question. We sought to investigate the outcomes of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> ‐guided compared with <jats:styled-content style="fixed-case">CA</jats:styled-content> ‐guided <jats:styled-content style="fixed-case">PCI</jats:styled-content> . </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> We performed a comprehensive search of PubMed, Medline, and Cochrane Central Register, looking for randomized controlled trials and observational studies that compared <jats:styled-content style="fixed-case">PCI</jats:styled-content> outcomes of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> with <jats:styled-content style="fixed-case">CA</jats:styled-content> . Data were aggregated for the primary outcome measure using the random‐effects model as pooled risk ratio ( <jats:styled-content style="fixed-case">RR</jats:styled-content> ). The primary outcomes were the rate of cardiovascular death, need for target lesion revascularization, occurrence of myocardial infarction, and rate of stent thrombosis. A total of 19 studies met the inclusion criteria, comprising 27 610 patients divided into <jats:styled-content style="fixed-case">IVUS</jats:styled-content> (n=11 513) and <jats:styled-content style="fixed-case">CA</jats:styled-content> (n=16 097). Compared with standard <jats:styled-content style="fixed-case">CA</jats:styled-content> ‐guided <jats:styled-content style="fixed-case">PCI</jats:styled-content> , we found that the risks of cardiovascular death ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.63; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.54–0.73), myocardial infarction ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.71; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.58–0.86), target lesion revascularization ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.81; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.70–0.94), and stent thrombosis ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.57; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.41–0.79) were all significantly lower using <jats:styled-content style="fixed-case">IVUS</jats:styled-content> guidance. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Compared with standard <jats:styled-content style="fixed-case">CA</jats:styled-content> ‐guided <jats:styled-content style="fixed-case">PCI</jats:styled-content> , the use of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis. </jats:p> </jats:sec>