Intravascular Ultrasound versus Angiography Guided Drug Eluting Stent Implantation in Patients with Left Main Coronary Artery Disease – A Systematic Review and Meta-Analysis

Kevin Karim^1,*, Mohammad Rizki Akbar¹, Miftah Pramudyo¹, Januar Wibawa Martha¹

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¹ Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, 40161 Bandung, Indonesia

^*Correspondence: kevinkarim.official@gmail.com (Kevin Karim)

Rev. Cardiovasc. Med. 2024, 25(1), 32; https://doi.org/10.31083/j.rcm2501032

Submitted: 26 July 2023 | Revised: 5 September 2023 | Accepted: 14 September 2023 | Published: 22 January 2024

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Several technical limitations exist in angiography procedures, including suboptimal visualization of a particular location and angiography only providing information about the contour of the vascular lumen, while intravascular ultrasound (IVUS) provides information regarding wall composition on coronary vascular lesions. With recent trials demonstrating IVUS benefits over standard angiography, our meta-analysis aimedto evaluate and summarize the current evidence on whether IVUS-guided drug-eluting stent (DES) placement resulted in better outcomes than the angiography-guided DES placement in patients with left main coronary artery (LMCA) disease. This meta-analysis aimed to analyze the current evidence on the IVUS-guided and angiography-guided drug-eluting stent (DES) placement in patients with LMCA disease. Methods: Literature searching was performed using Scopus, Embase, PubMed, EuropePMC, and Clinicaltrials.gov using PRISMA guidelines. The intervention group in our study are patients undergoing IVUS-guided percutaneous coronary intervention (PCI) and the control group are patients undergoing angiography alone-guided PCI. Cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis were compared between the two groups. Results: There were 11 studies comprising 24,103 patients included in this meta-analysis. IVUS-guided PCI was associated with lower cardiovascular mortality (hazard ratio (HR) 0.39 [95% CI 0.26, 0.58], p $<$ 0.001; I ${}^{2}$ : 75%, p $<$ 0.001) and all-cause mortality (HR 0.59 [95% CI 0.53, 0.66], p $<$ 0.001; I ${}^{2}$ : 0%, p = 0.45) compared to angiography alone guided PCI. The group receiving IVUS guided PCI has a lower incidence of myocardial infarction (HR 0.66 [95% CI 0.48, 0.90], p = 0.008; I ${}^{2}$ : 0%, p = 0.98), target lesion revascularization (HR 0.45 [95% CI 0.38, 0.54], p $<$ 0.001; I ${}^{2}$ : 41%, p = 0.10) and stent thrombosis (HR 0.38 [95% CI 0.26, 0.57], p $<$ 0.001; I ${}^{2}$ : 0%, p = 0.50) compared to the control group. Conclusions: Our meta-analysis demonstrated that IVUS-guided DES placement had lower cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis than angiography-guided DES implantation.