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Review
. 2022 Oct 8;9(10):343.
doi: 10.3390/jcdd9100343.

Comparison of Six Different Percutaneous Coronary Intervention Guidance Modalities

Mengjin Hu  1 , Jiangshan Tan  1 , Yuejin Yang  1
Affiliations
Review

Comparison of Six Different Percutaneous Coronary Intervention Guidance Modalities

Mengjin Hu et al. J Cardiovasc Dev Dis. .

Abstract

Background: New randomized trials and modalities in guiding percutaneous coronary intervention (PCI) have become available.

Objective: We aimed to compare the clinical outcomes of coronary angiography (CAG), intravascular ultrasound (IVUS), optical coherence tomography (OCT), fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and optical frequency domain imaging (OFDI)-guided PCI.

Methods: A network meta-analysis was performed to compare different PCI guidance modalities. The clinical outcomes included major adverse cardiovascular events (MACE), all-cause death, myocardial infarction (MI), and target vessel/lesion revascularization (TVR/TLR). Odds ratio (OR) and corresponding 95% credible interval (CrI) were calculated.

Results: Thirty-six randomized trials, including 19,042 patients, were included. In comparison with CAG, IVUS significantly reduced MACE (OR: 0.71; 95% CrI: 0.57 to 0.86) and TVR/TLR (OR: 0.53; 95% CrI: 0.43 to 0.66). MACE (OR: 1.44; 95% CrI: 1.02 to 2.08) and TVR/TLR (OR: 1.87; 95% CrI: 1.04 to 3.71) were significantly increased in the FFR group, compared with IVUS group. There were no significant differences in MACE or TVR/TLR among the left guidance modality comparisons. Differences in all-cause death or MI were not observed in any comparisons.

Conclusions: IVUS could reduce MACE and TVR/TLR, compared with CAG or FFR. Therefore, IVUS may be the optimal modality in guiding PCI.

Keywords: coronary angiography; fractional flow reserve; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention.

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Conflict of interest statement

All authors declared no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA diagram for study inclusion. CAG: coronary angiography; FFR: fractional flow reserve; iFR: instantaneous wave-free ratio; IVUS: intravascular ultrasound; OCT: optical coherence tomography; OFDI: optical frequency domain imaging.
Figure 2
Figure 2
Comparisons of clinical outcomes among guidance modalities included in the network meta-analysis. CAG: coronary angiography; FFR: fractional flow reserve; iFR: instantaneous wave-free ratio; IVUS: intravascular ultrasound; MACE: major adverse cardiovascular events; OCT: optical coherence tomography; OFDI: optical frequency domain imaging; TVR/TLR: target vessel/lesion revascularization. (A) MACE; (B) All-Cause Death; (C) Myocardial Infarction; (D) TVR/TLR.
Figure 3
Figure 3
Rank probability analysis for clinical outcomes among guidance modalities included in the network meta-analysis. CAG: coronary angiography; FFR: fractional flow reserve; iFR: instantaneous wave-free ratio; IVUS: intravascular ultrasound; MACE: major adverse cardiovascular events; OCT: optical coherence tomography; OFDI: optical frequency domain imaging; TVR/TLR: target vessel/lesion revascularization. (A) MACE; (B) All-Cause Death; (C) Myocardial Infarction; (D) TVR/TLR.
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