Abstract
Intracoronary imaging (ICI) facilitates stent implantation by characterizing lesion calcification, providing accurate vessel dimensions, and optimizing stent results. We sought to investigate the outcomes of routine ICI versus coronary angiography (CA) to guide percutaneous coronary intervention (PCI) with 2nd and 3rd-generation drug eluting stents. A systematic search of PubMed, Medline, and Cochrane databases was conducted from their inception to July 16, 2022 for randomized controlled trials (RCTs) comparing routine ICI to CA. The primary outcome was major adverse cardiovascular events (MACE). The secondary outcomes of interest were target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis, and cardiac and all-cause mortality. A random effects model was used to calculate pooled incidence and relative risk (RR) with 95% confidence intervals (CIs). Nine RCTs with 5,879 patients (2,870 ICI-guided and 3,009 CA-guided PCI) met the inclusion criteria. The ICI and CA groups were similar in demographic characteristics and comorbidity profiles. Compared to CA, patients in the routine ICI-guided PCI group had lower rates of MACE (RR 0.61, 95% CI 0.48-0.78, p<0.0001), TLR (RR 0.60, 95% CI 0.43-0.83, p=0.002), TVR (RR 0.72, 95% CI 0.51-1.00, p=0.05), and MI (RR 0.48, 95% CI 0.25-0.95, p=0.03). There were no significant differences in stent thrombosis or cardiac/all-cause mortality between the two strategies. In conclusion, routine ICI-guided PCI strategy, compared with CA guidance alone, is associated with improved clinical outcomes, largely driven by lower repeat revascularization.