Intravascular imaging guidance in complex PCI: a meta-analysis of randomized trials across complex lesion subsets.
Mattia Basile, Javier Gómez Herrero, Alejandro Lara García et al.
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In 30 seconds
This meta-analysis pooled randomized trials comparing intravascular imaging (IVI)-guided with angiography-guided PCI in patients with trial-defined complex PCI or extractable complex-lesion cohorts. Across 15 trials and 11,557 patients, IVI guidance was associated with lower target vessel failure (TVF; RR, 0.70; 95% confidence interval [CI], 0.56-0.86; number needed to treat, 26 [95% CI, 18-55]). Repeat revascularization and stent thrombosis were also reduced. Lesion-subset estimates favored IVI but were not significant in the primary analyses; all became significant after excluding IVUS-CHIP.
Key findings
- IVI guidance reduced TVF (RR, 0.70; 95% CI, 0.56-0.86; number needed to treat, 26 [95% CI, 18-55]).
- Target vessel revascularization (RR, 0.68; 95% CI, 0.53-0.87) and target lesion revascularization (RR, 0.67; 95% CI, 0.52-0.85) were lower with IVI.
- Stent thrombosis was reduced with IVI (RR, 0.42; 95% CI, 0.24-0.73); all-cause mortality was not reduced.
- Effects were similar for intravascular ultrasound and optical coherence tomography (interaction p = 0.93).
Why it matters
Complex PCI carries clinically important risks of vessel failure and repeat procedures. This pooled randomized-trial evidence suggests that imaging guidance can reduce TVF and several related complications compared with angiography guidance. The findings support considering IVI as a procedural strategy in complex PCI, while the uncertain lesion-specific results and absence of an all-cause mortality benefit temper conclusions about which patients benefit most.
What to keep in mind
Lesion-specific estimates were not significant in the primary analyses and became significant only after excluding IVUS-CHIP. The cardiovascular mortality finding was borderline, and lesion-subset effects were described as exploratory.