Is Intravascular Ultrasound-Guided Angiography a Better Choice Than Angiography Alone for Patients With Acute Coronary Syndrome and Coronary Artery Disease? Unveiling the Efficacy and Safety of This Modern Imaging Method: A Systematic Review and Meta-Analysis

Department

Medicine

Document Type

Article

Publication Title

Critical Pathways in Cardiology

Abstract

INTRODUCTION: Coronary angiography has been an established standard for over 6 decades for percutaneous coronary interventions (PCIs), but its role is limited to assessing vascular lumen and anterograde flow. In the 1980s, intravascular ultrasonography (IVUS) gained traction in interventional cardiology for its advantages over angiography. Despite its precise evaluation of plaque burden and vessel wall structure for optimizing stent implantation, the literature reports varying outcomes on the efficacy and safety of IVUS-guided angiography in patients presenting with acute coronary syndrome or coronary artery disease. To address this discrepancy, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of utilizing IVUS versus angiography alone for PCI in these groups of patients.

METHODS: We conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of IVUS-guided angiography in these patients. Electronic databases were searched, and 25 studies were included. Inclusion criteria are given as follows: (1) patients aged > 18 years, (2) patients with acute coronary syndrome or coronary artery disease undergoing IVUS-guided PCI or angiography-guided PCI, and (3) randomized controlled trials. Exclusion criteria comprised observational, nonrandomized studies, case reports, clinical spotlights, and review articles. Studied outcomes included all-cause mortality, cardiac death, myocardial infarction, target lesion revascularization (TLR), need for coronary artery bypass graft, and stent thrombosis (ST).

RESULTS: Compared with angiography alone, IVUS-guided PCI demonstrated a significant reduction in cardiac death, TLR, and ST regardless of the follow-up period. No significant difference was observed between the 2 groups concerning all-cause mortality, and myocardial infarction regardless of the follow-up period, and the need for coronary artery bypass graft at 1-year follow-up.

CONCLUSIONS: Compared with angiography-guided PCI, IVUS-guided PCI is associated with a lower incidence of cardiac death, TLR, and ST.

First Page

e0383

DOI

10.1097/HPC.0000000000000383

Volume

24

Issue

3

Publication Date

9-1-2025

Medical Subject Headings

Humans; Acute Coronary Syndrome; Ultrasonography, Interventional; Coronary Angiography; Coronary Artery Disease; Percutaneous Coronary Intervention

PubMed ID

40367300

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