Comparison of Intravascular Imaging, Functional or Angiographically Guided Coronary Intervention (JACC December 2023-1)-Article: Comparison of Intravascular Imaging, Functional or Angiographically Guided Coronary Intervention

Article: Comparison of Intravascular Imaging, Functional or Angiographically Guided Coronary Intervention

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A recent study conducted a network meta-analysis of randomized controlled trials (RCTs) to evaluate the best strategy for guiding percutaneous coronary intervention (PCI) in patients with and without acute coronary syndromes (ACS). The study compared the outcomes of intravascular imaging-guided PCI, functionally guided PCI, and angiography-guided PCI. The analysis included 32 eligible RCTs with a total of 22,684 patients.<br /><br />The results showed that both intravascular imaging-guided PCI and functionally guided PCI were associated with better outcomes compared to angiography-guided PCI. Intravascular imaging-guided PCI was found to be associated with a reduced risk of major adverse cardiovascular events (MACE), cardiovascular death, myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR) compared to angiography-guided PCI. Functionally guided PCI was also associated with a reduced risk of MACE and MI compared to angiography-guided PCI.<br /><br />Intravascular imaging-guided PCI was ranked as the best strategy for reducing the risk of cardiovascular events, including MACE, cardiovascular death, stent thrombosis, and TLR. These results were consistent in both ACS and non-ACS cohorts.<br /><br />The study highlights the potential benefits of using intravascular imaging or functional guidance, such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), to optimize outcomes in patients undergoing PCI. These findings suggest that intravascular imaging-guided PCI may be the most effective strategy for reducing the risk of cardiovascular events in patients undergoing PCI.

Keywords

network meta-analysis

percutaneous coronary intervention

intravascular imaging-guided PCI

functionally guided PCI

angiography-guided PCI

major adverse cardiovascular events

MACE

cardiovascular death

myocardial infarction

stent thrombosis