Coronary disease & ACS

Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention

J Am Coll CardiolPublished Systematic review and network meta-analysis of randomised trials

Pooled result · MACEResult — go to the resultRelative risk 0.72 95% CI 0.62–0.82

Authors' conclusion

Angiography-guided PCI had consistently worse outcomes compared with intravascular imaging-guided and functionally guided PCI. Intravascular imaging-guided PCI was the best strategy to reduce the risk of cardiovascular events.

Study context

Population
Patients undergoing percutaneous coronary intervention (PCI), with or without acute coronary syndromes (ACS)
Participants
22,684 patients32 RCTs
Comparison
Intravascular imaging-guided or functionally guided PCI vs angiography-guided PCI
Outcome
Trial-defined MACE:
  • CV death
  • MI
  • Target lesion revascularization
Methodological detailsP-score ranking
  • P-score ranking

Pooled result

MACE

Relative risk

0.72

95% CI 0.62–0.82

Intravascular imaging-guided PCIvs Angiography-guided PCI
RR 0.72 (95% CI 0.62–0.82)

As reported in the abstract

Further pooled results

OutcomeRR (95% CI)
CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided)Intravascular imaging-guided PCIvs Angiography-guided PCICV death0.56 (0.42–0.75)
CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided)Intravascular imaging-guided PCIvs Angiography-guided PCIMI0.81 (0.66–0.99)
CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided)Intravascular imaging-guided PCIvs Angiography-guided PCIStent thrombosis0.48 (0.31–0.73)
CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided)Intravascular imaging-guided PCIvs Angiography-guided PCITLR0.75 (0.57–0.99)

Myocardial infarction (MI) (functionally guided vs angiography-guided)

Functionally guided PCI associated with reduced risk of MI

Ranking (P scores)

Intravascular imaging-guided PCI ranked first for major adverse cardiovascular event (MACE), CV death, stent thrombosis and target lesion revascularization (TLR)

ACS and non-ACS cohorts (subgroup)

Results consistent in ACS and non-ACS cohorts

Original publication

Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention. J Am Coll Cardiol. Published 23 October 2023. doi:10.1016/j.jacc.2023.09.823

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