Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 82(23), 2167–2176. https://doi.org/10.1016/j.jacc.2023.09.823 Dr. Toshiki Kuno et al.
Points
- The study compares intravascular imaging-guided, functionally guided, and angiography-guided PCI outcomes.
- Intravascular imaging-guided PCI is associated with reduced risk of major adverse cardiovascular events (MACE), cardiovascular death, MI, stent thrombosis, and TLR.
- Functionally guided PCI also shows favorable outcomes regarding MACE and MI reduction compared to angiography-guided PCI.
- Intravascular imaging-guided PCI ranks first for various outcomes across ACS and non-ACS cohorts.
- Angiography-guided PCI consistently exhibits worse outcomes than intravascular imaging-guided and functionally-guided approaches.
Summary
In exploring optimal strategies for percutaneous coronary intervention (PCI), particularly in patients with acute coronary syndromes (ACS), the choice between intravascular imaging guidance, functional guidance, or conventional angiography remains ambiguous regarding outcome optimization.
This study sought to clarify this uncertainty by conducting a network meta-analysis of randomized controlled trials retrieved from PUBMED and EMBASE databases. The primary outcome assessed was major adverse cardiovascular events (MACE), encompassing cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR). The PCI strategies were evaluated and ranked based on P scores.
Analysis of 32 eligible trials involving 22,684 patients revealed compelling evidence favoring both intravascular imaging-guided and functionally guided PCI over angiography-guided PCI. Intravascular imaging-guided PCI demonstrated a consistent reduction in the risk of MACE, cardiovascular death, MI, stent thrombosis, and TLR compared to angiography-guided PCI. Similarly, functionally guided PCI exhibited favorable outcomes regarding MACE and MI reduction. Intravascular imaging-guided PCI ranked first for various outcomes across both ACS and non-ACS cohorts.
In conclusion, this meta-analysis underscores the inferiority of angiography-guided PCI compared to intravascular imaging-guided and functionally guided approaches. Intravascular imaging-guided PCI emerges as the preferred strategy for mitigating cardiovascular events, emphasizing the potential clinical significance of employing such guidance in PCI procedures.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723076830
References Kuno, T., Kiyohara, Y., Maehara, A., Ueyama, H. A., Kampaktsis, P. N., Takagi, H., Mehran, R., Stone, G. W., Bhatt, D. L., Mintz, G. S., & Bangalore, S. (2023). Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention. Journal of the American College of Cardiology, 82(23), 2167–2176. https://doi.org/10.1016/j.jacc.2023.09.823
