Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet, 403(10429), 824–837. https://doi.org/10.1016/S0140-6736(23)02454-6 Dr. Gregg W. Stone et al.
Points
- Systematic review and meta-analysis compared intravascular imaging-guided percutaneous coronary intervention (PCI) with angiography-guided PCI in patients with drug-eluting stents.
- Twenty-two trials involving 15,964 patients showed that intravascular imaging-guided PCI significantly reduced the risk of target lesion failure, encompassing cardiac death, target vessel-myocardial infarction, and target lesion revascularization.
- Both intravascular ultrasound and optical coherence tomography (OCT) guidance demonstrated similar outcomes, indicating consistent benefits of intravascular imaging guidance across different modalities.
- Intravascular imaging guidance significantly lowered the risks of adverse events, including cardiac death, TV-MI, target lesion revascularization, stent thrombosis, all myocardial infarction, and all-cause death compared to angiography guidance.
- The study’s findings underscore the substantial impact of intravascular imaging guidance in enhancing the safety and effectiveness of PCI with drug-eluting stents, providing valuable insights for clinical practice and decision-making.
Summary
A systematic review and meta-analysis aimed to evaluate the comparative performance of intravascular imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents versus angiography-guided PCI. The study, which included 22 trials and 15,964 patients, found that intravascular imaging-guided PCI resulted in a decreased risk of target lesion failure, defined as the composite of cardiac death, target vessel-myocardial infarction (TV-MI), or target lesion revascularization. The analysis revealed that intravascular imaging guidance, whether using intravascular ultrasound or optical coherence tomography (OCT), significantly reduced the risks of cardiac death, TV-MI, target lesion revascularization, stent thrombosis, all myocardial infarction, and all-cause death when compared with angiography guidance.
The findings from the meta-analysis demonstrated that intravascular imaging guidance, specifically with OCT or intravascular ultrasound, significantly enhanced PCI’s safety and effectiveness with drug-eluting stents. The study’s results indicated a substantial reduction in adverse outcomes, including death, myocardial infarction, repeat revascularization, and stent thrombosis when intravascular imaging guidance was employed. Notably, the outcomes were similar for both OCT-guided and intravascular ultrasound-guided PCI, suggesting that the benefits of intravascular imaging guidance were consistent across different imaging modalities.
In conclusion, the systematic review and meta-analysis provided compelling evidence supporting the superiority of intravascular imaging-guided PCI over angiography-guided PCI in coronary stent implantation with drug-eluting stents. The study’s results underscore the significant impact of intravascular imaging guidance in reducing adverse cardiovascular events and improving the overall safety and efficacy of PCI procedures.
Link to the article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02454-6/abstract
References Stone, G. W., Christiansen, E. H., Ali, Z. A., Andreasen, L. N., Maehara, A., Ahmad, Y., Landmesser, U., & Holm, N. R. (2024). Intravascular imaging-guided coronary drug-eluting stent implantation: An updated network meta-analysis. The Lancet, 403(10429), 824–837. https://doi.org/10.1016/S0140-6736(23)02454-6
