Coronary disease & ACSMeta-analysis
Intracoronary Imaging-Guided Percutaneous Coronary Intervention
- Systematic review and meta-analysis of randomised trials
- trial sequential analysis
- fragility analysis
- Bayesian meta-analysis
- meta-regression
Authors' conclusion
In this updated meta-analysis of RCTs, after accounting for modifier effects from recent studies, ICI-guided PCI was associated with significantly reduced cardiovascular events compared with angiography-guided PCI. Geographic heterogeneity across trials was present mainly for target vessel revascularization, explained in large part by differences in lesion characteristics and procedural technique.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI) in the drug-eluting stent era
- Participants
- 24,634 patients · 28 randomized controlled trials (RCTs)
- Comparison
- Intracoronary imaging (ICI)-guided PCI vs angiography-guided PCI
Pooled result
As reported in the abstract
Target lesion failure, cardiac mortality, MI, target vessel revascularization, stent thrombosis and all-cause mortality · mean follow-up 22 months
ICI-guided PCI vs Angiography-guided PCIRR
target lesion failure; I2 = 61%
0.72(95% CI 0.61–0.85)
cardiac mortality; I2 = 5%
0.73(CI 0.58–0.91)
MI; I2 = 0%
0.86(CI 0.75–0.97)
target vessel revascularization; I2 = 41%
0.69(95% CI 0.57–0.83)
stent thrombosis; I2 = 0%
0.55(95% CI 0.40–0.76)
all-cause mortality; I2 = 0%
0.82(95% CI 0.70–0.96)
Further pooled results
Trial sequential, fragility and Bayesian analyses
- Fragility index range
- 9 to 50
- Posterior probability for benefit, all outcomes
- >99%
- Trial sequential analysis confirmed at least a 20% reduction in all outcomes with ICI-guided PCI
Between-trial heterogeneity (meta-regression)
- Geography and lesion characteristics explained most between-trial variance (residual tau)
- 0
Original publication
Intracoronary Imaging-Guided Percutaneous Coronary Intervention. J Am Coll Cardiol. Published 10 September 2026. doi:10.1016/j.jacc.2026.08.008
Summarised from the published abstract; every number is checked against it