Coronary disease & ACSMeta-analysis
Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention
- Systematic review and network meta-analysis of randomised trials
- P-score ranking
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 patients · 32 RCTs
- Comparison
- Intravascular imaging-guided or functionally guided PCI vs angiography-guided PCI
- Outcome
- Trial-defined MACE:
- CV death
- MI
- Target lesion revascularization
Pooled result
MACE
Relative risk
0.72
95% CI 0.62–0.82
Intravascular imaging-guided PCI vs Angiography-guided PCI
RR 0.72 (95% CI 0.62–0.82)
As reported in the abstract
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided) — Intravascular imaging-guided PCI vs Angiography-guided PCI · CV death | 0.56 (0.42–0.75) | |
| CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided) — Intravascular imaging-guided PCI vs Angiography-guided PCI · MI | 0.81 (0.66–0.99) | |
| CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided) — Intravascular imaging-guided PCI vs Angiography-guided PCI · stent thrombosis | 0.48 (0.31–0.73) | |
| CV death, MI, stent thrombosis, TLR (imaging-guided vs angiography-guided) — Intravascular imaging-guided PCI vs Angiography-guided PCI · TLR | 0.75 (0.57–0.99) | |
| 0.20.5125Relative risk (log scale) |
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
Summarised from the published abstract; every number is checked against it