Angiographic-only or intravascular ultrasound-guided approach for left-main coronary artery intervention: a systematic review and meta-analysis

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.

KEYWORDS:

• Angiography
• intravascular ultrasound
• left main coronary artery disease
• percutaneous coronary intervention

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.

Additional information

Funding

This paper was not funded.