What question did this study set out to answer?

To compare the efficacy and safety of IVUS-guided versus angiography-guided PCI in treating ULMCA disease.

February 2, 2026European Heart Journal - Cardiovascular Imaging0 citations

Revascularization strategies for left main coronary lesions: a meta-analysis of ultrasound-guided and angiography-directed PCI outcomes

Key Points

To compare the efficacy and safety of IVUS-guided versus angiography-guided PCI in treating ULMCA disease.
Conducted a systematic review and meta-analysis of RCTs and propensity score-matched studies.
Included 12 studies with 15,370 patients in total.
Assessed study quality using Cochrane ROB 2.0 and ROBINS-I tools.
Analyzed outcomes using random-effects models in R software.
IVUS guidance led to a 40% reduction in major adverse cardiovascular events.
All-cause mortality was reduced by 35% with IVUS guidance.
Cardiac mortality decreased by 56% with IVUS guidance compared to angiography.
Myocardial infarction rates dropped by 30% using IVUS guidance.
Stent thrombosis rates were 62% lower with IVUS guidance compared to conventional methods.

Abstract

Abstract Background Unprotected left main coronary artery (ULMCA) disease represents the most prognostically significant manifestation of coronary artery disease, carrying substantial risks of cardiovascular mortality and morbidity. While coronary artery bypass grafting (CABG) has traditionally been the gold standard, percutaneous coronary intervention (PCI) with drug-eluting stents has emerged as a viable alternative for select patients, as demonstrated in contemporary clinical trials. However, conventional angiographic guidance presents inherent limitations in complex lesion assessment. Methods We conducted a systematic evidence synthesis comparing intravascular ultrasound (IVUS)-guided versus angiography-guided PCI for ULMCA disease, incorporating randomized controlled trials and propensity score-matched observational studies. Following PRISMA guidelines, we comprehensively searched multiple databases through March 2024. Study quality was assessed using Cochrane ROB 2.0 and ROBINS-I tools. Primary and secondary outcomes were analyzed using random-effects models in R software. Results Our analysis included 12 studies (3 RCTs, 9 PSM studies) encompassing 15,370 patients. IVUS guidance demonstrated superior outcomes across multiple endpoints: significant reductions in major adverse cardiovascular events (RR 0.60, 95% CI 0.49-0.74), all-cause mortality (RR 0.65, 0.59-0.72), cardiac mortality (RR 0.44, 0.30-0.63), myocardial infarction (RR 0.70, 0.57-0.85), stent thrombosis (RR 0.38, 0.21-0.70), and revascularization endpoints (TLR RR 0.55, 0.33-0.91; TVR RR 0.64, 0.46-0.91). Heterogeneity was generally low (I²50%) across analyses. Conclusions This comprehensive meta-analysis establishes IVUS guidance as superior to conventional angiography for ULMCA PCI, demonstrating significant improvements in both safety and efficacy outcomes. The tomographic visualization provided by IVUS enables precise lesion assessment and stent optimization, addressing key limitations of two-dimensional angiography.

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