1. Target-vessel failure was significantly lower in the ultrasound-guided group than the angiography-guided group.

2. There was no significant difference between groups concerning stent thrombosis.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Angiography-guided percutaneous coronary intervention (PCI) is the current standard of care for patients with coronary artery stenosis, although this is associated with complications. Intravascular ultrasound (IVUS) has shown advantages over angiography in coronary interventions, but its benefits and safety profile for acute coronary syndrome (ACS) patients remain unclear. This randomized controlled trial aimed to assess whether IVUS guidance improves outcomes for ACS patients undergoing PCI with contemporary drug-eluting stents. The primary outcome was target-vessel failure, composed of cardiac death, and target vessel myocardial infarction while the key secondary outcome was stent thrombosis. According to study results, IVUS-guided PCI significantly reduced target-vessel failure without any differences in stent thrombosis. Although this study was well done, it was limited by a lack of data on long-term outcomes.

Click to read the study in The Lancet

Relevant Reading: Intravascular Imaging–Guided or Angiography-Guided Complex PCI

In-depth [randomized controlled trial]: Between Aug 20, 2019, and Oct 27, 2022, 3710 patients were screened across 58 centers in China, Italy, Pakistan, and the UK. Included were patients aged ≥ 18 years with ACS in a previously untreated coronary artery segment and an indication for PCI. Altogether, 3505 patients (1753 in ultrasound-guided and 1752 in angiography-guided PCI groups) were included in the final analysis. The primary outcome of target-vessel failure was significantly higher in the ultrasound-guided group than PCI-guided group (4.0% vs. 7.3%, hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.41-0.74, p=0.0001). The secondary outcome of stent thrombosis showed no significant difference between groups. Findings from this study suggest that intravascular ultrasound-guided PCI improves outcomes in ACS patients compared to angiography guidance alone.

Image: PD

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