Harmouch Khaled M, Haider Mobeen, Hamza Mohammad, Upreti Prakash, Bahar Yasemin, Turkmani Mustafa, Rrapo Tea, Kumar Nomesh, Kumar Manoj, Safdar Wasif, Sattar Yasar, Zafrullah Fnu, Mhafouz Abu, Alraies M Chadi
From the Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI.
Department of Cardiology, West Virginia University, Morgantown, WV.
Crit Pathw Cardiol. 2025 Sep 1;24(3):e0383. doi: 10.1097/HPC.0000000000000383. Epub 2025 May 12.
Coronary angiography has been an established standard for over 6 decades for percutaneous coronary interventions (PCIs), but its role is limited to assessing vascular lumen and anterograde flow. In the 1980s, intravascular ultrasonography (IVUS) gained traction in interventional cardiology for its advantages over angiography. Despite its precise evaluation of plaque burden and vessel wall structure for optimizing stent implantation, the literature reports varying outcomes on the efficacy and safety of IVUS-guided angiography in patients presenting with acute coronary syndrome or coronary artery disease. To address this discrepancy, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of utilizing IVUS versus angiography alone for PCI in these groups of patients.
We conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of IVUS-guided angiography in these patients. Electronic databases were searched, and 25 studies were included. Inclusion criteria are given as follows: (1) patients aged >18 years, (2) patients with acute coronary syndrome or coronary artery disease undergoing IVUS-guided PCI or angiography-guided PCI, and (3) randomized controlled trials. Exclusion criteria comprised observational, nonrandomized studies, case reports, clinical spotlights, and review articles. Studied outcomes included all-cause mortality, cardiac death, myocardial infarction, target lesion revascularization (TLR), need for coronary artery bypass graft, and stent thrombosis (ST).
Compared with angiography alone, IVUS-guided PCI demonstrated a significant reduction in cardiac death, TLR, and ST regardless of the follow-up period. No significant difference was observed between the 2 groups concerning all-cause mortality, and myocardial infarction regardless of the follow-up period, and the need for coronary artery bypass graft at 1-year follow-up.
Compared with angiography-guided PCI, IVUS-guided PCI is associated with a lower incidence of cardiac death, TLR, and ST.
冠状动脉造影术作为经皮冠状动脉介入治疗（PCI）的既定标准已有60多年，但它的作用仅限于评估血管腔和正向血流。20世纪80年代，血管内超声检查（IVUS）因其相对于血管造影术的优势而在介入心脏病学中受到关注。尽管它能精确评估斑块负荷和血管壁结构以优化支架植入，但文献报道IVUS引导下血管造影术在急性冠状动脉综合征或冠状动脉疾病患者中的疗效和安全性结果各异。为解决这一差异，我们进行了一项全面的系统评价和荟萃分析，以评估在这些患者群体中使用IVUS与单纯血管造影术进行PCI的疗效和安全性。
我们进行了一项全面的系统评价和荟萃分析，以评估IVUS引导下血管造影术在这些患者中的疗效和安全性。检索了电子数据库，纳入了25项研究。纳入标准如下：（1）年龄>18岁的患者；（2）接受IVUS引导下PCI或血管造影术引导下PCI的急性冠状动脉综合征或冠状动脉疾病患者；（3）随机对照试验。排除标准包括观察性、非随机研究、病例报告、临床聚焦和综述文章。研究结局包括全因死亡率、心源性死亡、心肌梗死、靶病变血运重建（TLR）、冠状动脉旁路移植术需求和支架血栓形成（ST）。
与单纯血管造影术相比，无论随访期如何，IVUS引导下PCI的心源性死亡、TLR和ST均显著降低。两组在全因死亡率、无论随访期的心肌梗死以及1年随访时冠状动脉旁路移植术需求方面均未观察到显著差异。
与血管造影术引导下PCI相比，IVUS引导下PCI的心源性死亡、TLR和ST发生率较低。
