ESC Congress 2023
Intravascular imaging-guided percutaneous coronary intervention (PCI) is associated with a lower rate of target lesion failure compared with angiography-guided PCI, according to research presented at the ESC Congress 2023.
Numerous randomised trials have compared intravascular imaging-guided PCI with angiography-guided PCI. However, most of these prior trials have used intravascular ultrasound (IVUS). Optical coherence tomography (OCT) is a newer intravascular imaging modality that has enhanced resolution compared to IVUS. Two randomised trials of OCT-guided versus angiography-guided PCI were presented for the first time, the ILUMIEN IV trial in high-risk patients with complex lesions and the OCTOBER trial in bifurcation lesions.
The authors of the current study performed a real-time updated network meta-analysis, integrating data from the ILUMIEN IV and OCTOBER trials with prior studies, to examine the effects of intravascular imaging guidance versus angiography guidance. The analysis compared:
1. The overall effects of intravascular imaging (IVUS and OCT) in improving outcomes of the PCI procedure versus angiography;
2. IVUS versus angiography;
3. OCT versus angiography; and
4. IVUS versus OCT.
The analysis incorporated 20 randomised trials of intravascular imaging-guided PCI compared with angiography-guided PCI in 12,428 patients with chronic and acute coronary syndromes. Of those, 7,038 were randomly allocated to intravascular imaging guidance (including 3,120 patients randomised to IVUS guidance, 2,826 patients randomised to OCT guidance, and 1,092 patients randomised to IVUS or OCT guidance), and 5,390 patients were randomly allocated to angiography guidance. Patients were followed for between 6 months and 5 years. The primary endpoint was target lesion failure, defined as a “composite of cardiac death, target vessel myocardial infarction”, or target lesion revascularisation. Secondary endpoints included cardiac death, target vessel myocardial infarction, target lesion revascularisation, and stent thrombosis, as well as all-cause death, all myocardial infarction and target vessel revascularisation.