Intravascular Imaging-guided Percutaneous Coronary Intervention in Patients With and Without Diabetes: A Meta-analysis of Randomized Trials.
Hendrianus Hendrianus, Sang Yeub Lee, Hoyoun Won et al.
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In 30 seconds
This meta-analysis pooled 11 randomized controlled trials (n = 17,692) comparing intravascular imaging-guided with angiography-guided PCI, with outcomes assessed by diabetes status. The primary outcome was target vessel failure (TVF) at ≥ 1 year. Imaging-guided PCI was associated with lower TVF in patients with diabetes (RR 0.69, 95% CI 0.53-0.90) and without diabetes (RR 0.65, 95% CI 0.55-0.77); there was no evidence that the effect differed by diabetes status (P interaction = 0.72).
Key findings
- In patients with diabetes, imaging-guided PCI reduced TVF versus angiography guidance (RR 0.69, 95% CI 0.53-0.90; P = 0.006).
- In patients without diabetes, imaging-guided PCI reduced TVF (RR 0.65, 95% CI 0.55-0.77; P < 0.001).
- The effect did not differ significantly by diabetes status (P interaction = 0.72).
- Exploratory head-to-head analyses found no difference in TVF risk between OCT and IVUS, with consistent findings across diabetes status.
Why it matters
The findings suggest that the reduction in TVF associated with intravascular imaging-guided PCI is not confined to patients with or without diabetes. This supports considering diabetes status alongside other clinical and procedural factors rather than assuming it changes the relative benefit of imaging guidance. Subgroup estimates for complex PCI in diabetes were imprecise.
What to keep in mind
The meta-analysis combines trials with different imaging approaches and PCI populations; estimates for some diabetic subgroups were imprecise. Meta-regression identified age and follow-up duration as potential effect modifiers in patients with diabetes.