ABSTRACT
Introduction
The use of intravascular ultrasound (IVUS) in percutaneous revascularization of left-main coronary artery disease (LMCAD) warrants further exploration. We aimed to collate all available data on the merits of IVUS in LMCAD to help decision-making.
Methods
The MEDLINE, Embase, and Cochrane databases were queried for relevant randomized controlled trials (RCTs) and observational cohort studies (OCS). The data were analyzed using random-effects model to calculate unadjusted odds ratio (OR) between IVUS-guided and angiography-only LMCA revascularization.
Results
A total of 14 studies (2 RCTs and 12 OCS), comprising 18944 patients, were included. The pooled odds of all-cause mortality (OR 0.57, 95%CI 0.46–0.70, p = <0.00001), cardiovascular mortality (OR 0.37, 95%CI 0.26–0.54, p = <0.00001), left-main revascularization (OR 0.63, 95%CI 0.45–0.89, p = 0.009) and myocardial infarction (OR 0.80, 95% CI 0.66–0.97, p = 0.02) were significantly lower with IVUS-guidance. There was no difference observed in the odds of the stent thrombosis (OR 0.57, 95% CI 0.31–1.05, p = 0.07) and stroke (OR 1.7, 95%CI 0.56–5.14, p = 0.35) between the two groups. A subgroup analysis based on the study design and follow-up duration mirrored the pooled estimates.
Conclusion
IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than the angiography-only approach. This needs to be tested in a large randomized controlled trial.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Sameer Saleem: Conception and writing
Waqas Ullah: Analysis, study design, execution
Maryam Mukhtar: Acquisition of data
Deepika Sarvepalli: Acquisition of data
Sundas Younas: Acquisition of data
Shuaib Ahmed Arab: Interpretation
Bashar Al Hemyari: Writing
Salman Zahid: Analysis
Salik Nazir: Critical Review
Tayyab Cheema: Writing
Tanveer Mir: Writing and Validation
Mohammad Abdul-Waheed: Supervision, Critical Review
Supplementary material
Supplemental data for this article can be accessed here.