Cardiology > > PCI– Updated meta-analysis offers strong motivation for IVUS, OCT adoption
by Nicole Lou, Senior Staff Writer, MedPage Today February 21, 2024
For the very first time, intravascular imaging-guided coronary stenting was related to much better survival and decreased myocardial infarction (MI) in a meta-analysis powered to find these advantages versus angiography, scientists reported.
Randomized to optical coherence tomography (OCT) or intravascular ultrasound (IVUS) assistance, clients who went through percutaneous coronary intervention (PCI) with modern stents revealed a decline in target sore failure (RR 0.71, 95% CI 0.63-0.80) and its specific endpoint parts of:
- Heart death: RR 0.55 (95% CI 0.41-0.75)
- Target vessel MI: RR 0.82 (95% CI 0.68-0.98)
- Target sore revascularization: RR 0.72 (95% CI 0.60-0.86)
In addition, the 2 intravascular imaging methods were connected to reductions in stent apoplexy (RR 0.52, 95% CI 0.34-0.81), all MI (RR 0.83, 95% CI 0.71-0.99), and all-cause death (RR 0.75, 95% CI 0.60-0.93) when individuals were followed for a weighted average of 24.7 months, reported a group led by Gregg Stone, MD, of Icahn School of Medicine at Mount Sinai in New York City.
“Compared with angiography assistance, intravascular imaging assistance of coronary stent implantation with OCT or intravascular ultrasound improves both the security and efficiency of PCI,” the authors concluded in The Lancet
“To put these lead to viewpoint, drug-eluting stents [DES] do not lower death, myocardial infarction, or stent apoplexy compared to bare metal stents, yet are advised with class I proof in social standards for their decrease in repeat revascularization alone,” they composed.
IVUS and OCT imaging are still stuck with a weak class IIa recommendation from social standards on coronary revascularization regardless of older proof that they lower composite heart occasions and repeat revascularization compared with angiographic assistance alone.
“In contrast to the plateau in scientific results that has actually been reached with drug-eluting stent innovation, event-free survival may still be significantly enhanced by implanting drug-eluting stents with intravascular imaging assistance,” Stone and coworkers worried.
The research study authors recommended higher adoption of IVUS and OCT in mainstream medical practice based upon the meta-analysis. “These information call for efforts to get rid of staying obstacles to the regular usage of intravascular imaging, consisting of training and compensation concerns,” Stone’s group advised.
Zhong Shiun Lee, MBBS, and Nicola Ryan, MBBCh, MPH, both of Aberdeen Royal Infirmary in Scotland, concurred.
“To date, the concern amongst scientific interventional cardiologists typically focuses on when intravascular imaging must be utilized to direct PCI,” they composed in an accompanying editorial.”[F]ollowing this meta-analysis the concern undoubtedly ends up being why are we not utilizing intravascular imaging to assist PCI?”
“Substantial factor to consider to updating using intravascular imaging to a class I suggestion in future standards ought to take place as an outcome of the increased procedural security and effectiveness with using intravascular imaging shown by this meta-analysis,” according to the editorialists.