Outcomes of Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Interventions in Chronic Total Occlusions: A Systematic Review and Meta-Analysis.
Department
Medicine
Document Type
Article
Publication Title
The Journal of Invasive Cardiology
Abstract
BACKGROUND: Percutaneous coronary interventions (PCI) with intravascular ultrasound (IVUS) guidance have been associated with better long-term outcomes, but adoption remains limited. There are limited data on the impact of IVUS on chronic total occlusion (CTO)-PCI.
OBJECTIVES: To examine the impact of IVUS guidance on the outcomes of CTO-PCI.
METHODS: We performed a systematic review and study-level meta-analysis of IVUS vs angiography-guided CTO-PCI. Electronic databases were systematically searched for all pertinent studies from inception through January 2021. Randomized controlled trials (RCT), registry data, and abstracts published in peer-reviewed indexed journals were included. We examined the following in-hospital and long-term outcomes: major adverse cardiac events; all-cause mortality; cardiovascular mortality; myocardial infarction (MI); target-vessel revascularization (TVR); target-lesion revascularization (TLR); and stent thrombosis (ST). We also evaluated the following procedural metrics: procedure time; fluoroscopy time; contrast volume; total stent length; and total number of stents. Random-effects models were used to pool individual study results.
RESULTS: Four (2 observational, 2 randomized) studies including 1975 patients (IVUS-guided PCI, 861 patients; angiography-guided PCI, 1114 patients) were included in the analysis. IVUS-guided CTO-PCI had similar all-cause mortality, major adverse cardiac events, cardiovascular mortality, MI, TVR, and TLR compared with angiography-guided CTO-PCI, but lower risk of stent thrombosis (odds ratio, 0.24; 95% confidence interval, 0.08-0.76; P=.02; I²=0%), shorter procedure time (P
CONCLUSION: IVUS-guided CTO-PCI is associated with lower risk of ST.
First Page
E310
Last Page
E318
Volume
34
Issue
4
Publication Date
4-1-2022
Medical Subject Headings
Coronary Angiography; Drug-Eluting Stents; Humans; Percutaneous Coronary Intervention; Ultrasonography; Ultrasonography, Interventional
PubMed ID
35366225
Recommended Citation
Chugh, Y., Buttar, R., Kwan, T., Vemmou, E., Karacsonyi, J., Nikolakopoulos, I., Garcia, S., Goessl, M., Wang, Y., Chavez, I., Poulose, A., Burke, M., & Brilakis, E. (2022). Outcomes of Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Interventions in Chronic Total Occlusions: A Systematic Review and Meta-Analysis.. The Journal of Invasive Cardiology, 34 (4), E310-E318. Retrieved from https://scholar.rochesterregional.org/rrhpubs/1422