Which PCI strategy is best for reducing cardiovascular events?

Compared with intravascular imaging-guided and functionally guided percutaneous coronary intervention (PCI), angiography-guided PCI has consistently resulted in worse cardiovascular outcomes, a study has shown.

A team of investigators searched the databases of PubMed and Embase for randomized controlled trials (RCTs) that evaluated the outcomes with intravascular imaging-guided, functionally guided, or angiography-guided PCI. These strategies were then ranked from best to worst using P scores.

The primary outcome was trial-defined major adverse cardiovascular event (MACE), which is a composite of cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR).

Thirty-two RCTs including a total of 22,684 patients met the eligibility criteria.

Compared with angiography-guided PCI, intravascular imaging-guided PCI correlated with lower risk of MACE (relative risk [RR], 0.72, 95 percent confidence interval [CI], 0.62‒0.82), cardiovascular death (RR, 0.56, 95 percent CI, 0.42‒0.75), MI (RR, 0.81, 95 percent CI, 0.66‒0.99), stent thrombosis (RR, 0.48, 95 percent CI, 0.31‒0.71), and TLR (RR, 0.75, 95 percent CI, 0.57‒0.99).

Functionally guided PCI, compared with angiography-guided PCI, also resulted in reduced risks of MI and MACE. Of all the PCI strategies, intravascular imaging-guided PCI turned out to be best for outcomes such as MACE, cardiovascular death, stent thrombosis, and TLR. These results persisted in the acute coronary syndrome (ACS) and non-ACS cohorts.

“Intravascular imaging-guided PCI was the best strategy to reduce the risk of cardiovascular events,” the investigators said.