Intravascular ultrasound beats angiography at guiding PCI in AMI

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) significantly improves survival in patients with acute myocardial infarction (AMI), a recent study has found.

Researchers conducted a systematic review and meta-analysis of nine studies retrieved from the online databases of Embase, Medline, Web of Science, Google Scholar, and the Cochrane Central Register of Controlled Trials. The primary endpoint was all-cause mortality compared between IVUS- and angiography-guided PCI.

Pooled random-effects analysis showed that IVUS was significantly better than angiography for survival, cutting the risk of all-cause mortality by 30 percent (pooled risk ratio [RR], 0.70, 95 percent confidence interval [CI], 0.59­–0.82; p<0.01). A similarly significant benefit was reported for the secondary outcome of major adverse cardiovascular events (MACE; pooled RR, 0.86, 95 percent CI, 0.74–0.99; p=0.04).

Risk of bias was low for the analysis on all-cause mortality, while the funnel plot for MACE showed slight asymmetry. Overall, seven studies had moderate risk of bias, while one had serious such risk due to inappropriate adjustment. One randomized controlled trial was included in the analysis and was found to have some bias concerns.

IVUS-guided PCI was also superior in terms of target vessel revascularization (TVR; pooled RR, 0.83, 95 percent CI, 0.73–0.95; p<0.01) but had no such effect on cardiac death (pooled RR, 0.62, 95 percent CI, 0.29–1.33; p=0.22).

“This is the first systematic review and meta-analysis comparing IVUS- versus angio-guided PCI in patients with AMI, showing a beneficial effect of IVUS-guided PCI on all-cause mortality, MACE, and TVR,” the researchers said. “Results of ongoing dedicated prospective studies are needed to confirm these findings.”