# Comparison of intravascular imaging, physiological assessment and angiography for coronary revascularization in acute coronary syndrome: a systematic review and network meta-analysis

## TL;DR

This study compares different techniques for coronary interventions in heart attack patients and finds that imaging and physiological assessments reduce risks better than standard angiography.

## Contribution

A network meta-analysis comparing intravascular imaging and physiological assessment techniques for PCI in acute coronary syndrome.

## Key findings

- IVUS- and FFR-guided PCI reduce the risk of major adverse cardiac events compared to angiography.
- QFR-guided PCI is associated with lower all-cause mortality than angiography.
- FFR-guided PCI shows lower MACE risk than angiography-guided procedures in some subgroups.

## Abstract

The optimal percutaneous coronary intervention (PCI) technique to treat acute coronary syndrome (ACS) requires further investigation. This network meta-analysis evaluated the effects of physiological assessment and intravascular imaging techniques on the prevalence of adverse cardiac outcomes following PCIs.

We reviewed PubMed, Cochrane, and EMBASE databases for the purpose of identifying all randomized control trials published up to October 30, 2024, comparing the impact of intravascular imaging, physiology assessment, or angiography techniques on outcomes. The primary outcome for this research was major adverse cardiovascular events (MACE) occurrences. Each PCI strategy was ranked as per the risk ratio (RR) at the 95% confidence interval (95% CI) for developing MACE.

Twenty-eight RCTs with 18,221 patients were identified. Compared with angiography, intravascular ultrasound (IVUS)- (RR: 0.62; 95%CI: 0.46–0.85) and fractional flow reserve (FFR)-guided PCI (RR: 0.62; 95%CI: 0.46–0.85) reduced the risk of MACE. Patients who received quantitative flow ratio (QFR)-guided PCI experienced lower all-cause mortality (RR: 0.25; 95%CI: 0.07–0.92) vs. those receiving angiography. Similarly, the RR decreased to 0.64 after using FFR-guided PCI vs. angiographic procedures (95% CI: 0.44–0.91). Compared to angiography, the subgroup analysis showed inconsistent results for IVUS-guided PCI in preventing MACE for both the optimization (RR: 0.60; 95%CI: 0.49–0.74) and decision-making (RR: 0.55; 95%CI: 0.05–6.18). The likelihood of developing MACE was lower for FFR-guided CR than for angiography-guide culprit-only PCIs (RR-0.72; 95%CI: 0.53–0.97), as confirmed by sensitivity assessment results. The research unveiled no statistically significant differences between FFR-guided culprit-only PCIs and culprit-only PCIs or angiography-guided CR.

IVUS- and FFR-guided PCI lowers the MACE risk in patients with ACS. In addition, IVUS achieved the best results in ACS patients undergoing PCI.

INPLASY (inplasy.com), INPLASY202420092.