Intravascular ultrasound-guided versus coronary angiography-guided percutaneous coronary intervention in patients with acute myocardial infarction: A systematic review and meta-analysis. (15th April 2022)

• Record Type: Journal Article
• Authors: Groenland, Frederik T.W.; Neleman, Tara; Kakar, Hala; Scoccia, Alessandra; Ziedses des Plantes, Annemieke C.; Clephas, Pascal R.D.; Chatterjee, Sraman; Zhu, Mahova; den Dekker, Wijnand K.; Diletti, Roberto; Zijlstra, Felix; Mahmoud, Karim D.; Van Mieghem, Nicolas M.; Daemen, Joost
• Is Part Of: International journal of cardiology. Volume 353(2022)
• Page Start: 35
• Page End: 42
• Publication Date: 2022-04-15
• Subjects: Acute myocardial infarction -- Coronary angiography -- Intravascular ultrasound -- Percutaneous coronary intervention; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.01.021
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Intravascular ultrasound (IVUS) can overcome the intrinsic limitations of coronary angiography for lesion assessment and stenting. IVUS improves outcomes of patients presenting with stable or complex coronary artery disease, but dedicated data on the impact of IVUS-guided percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) remains scarce. Methods: We systematically searched Embase, MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Google Scholar for studies that compared clinical outcomes for IVUS- versus angio-guided PCI in patients with AMI. The primary endpoint was all-cause mortality and the secondary endpoint major adverse cardiovascular events (MACE). Mantel-Haenszel random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Results: Nine studies (8 observational, 1 RCT) with a total of 838.902 patients (796.953 angio-guided PCI, 41.949 IVUS-guided PCI) were included. In patients with AMI, IVUS-guided PCI was associated with a significantly lower risk of all-cause mortality (pooled RR: 0.70; 95% CI, 0.59–0.82; p < 0.01), MACE (pooled RR: 0.86; 95% CI, 0.74–0.99; p = 0.04) and target vessel revascularization (TVR) (pooled RR: 0.83; 95% CI, 0.73–0.95; p < 0.01). In the subset of patients presenting with ST-segment elevation, IVUS-guided PCI remained associated with a reduced risk for both all-cause mortality (pooled RR: 0.79; 95% CI, 0.66–0.95, p = 0.01) and MACE (pooled RR: 0.86; 95% CI, 0.74–0.99, p = 0.04). Conclusions: This is the first systematic review and meta-analysis comparing IVUS- versus angio-guided PCI in patients with AMI, showing a beneficial effect of IVUS-guided PCI on all-cause mortality, MACE and TVR. Results of ongoing dedicated prospective studies are needed to confirm these findings. Highlights: First systematic review and meta-analysis comparing IVUS- versus angio-guided PCI in acute myocardial infarction. Nine studies with a total of 838.902 patients (796.953 angio-guided PCI, 41.949 IVUS-guided PCI) were included. IVUS-guided PCI was associated with a beneficial effect on all-cause mortality, MACE and TVR. For all-cause mortality, MACE and TVR, pooled risk ratios in favor of IVUS were 0.70, 0.86 and 0.83 ( p < 0.05 for all). Results of dedicated ongoing prospective studies are needed to confirm these findings.