Background
Intravascular ultrasound (
IVUS
) guidance during percutaneous coronary intervention (
PCI
) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of
PCI
. However, the long‐term beneficial effect of
IVUS
over
PCI
guided by coronary angiography (
CA
) alone remains under question. We sought to investigate the outcomes of
IVUS
‐guided compared with
CA
‐guided
PCI
.
Methods and Results
We performed a comprehensive search of PubMed, Medline, and Cochrane Central Register, looking for randomized controlled trials and observational studies that compared
PCI
outcomes of
IVUS
with
CA
. Data were aggregated for the primary outcome measure using the random‐effects model as pooled risk ratio (
RR
). The primary outcomes were the rate of cardiovascular death, need for target lesion revascularization, occurrence of myocardial infarction, and rate of stent thrombosis. A total of 19 studies met the inclusion criteria, comprising 27 610 patients divided into
IVUS
(n=11 513) and
CA
(n=16 097). Compared with standard
CA
‐guided
PCI
, we found that the risks of cardiovascular death (
RR
, 0.63; 95%
CI
, 0.54–0.73), myocardial infarction (
RR
, 0.71; 95%
CI
, 0.58–0.86), target lesion revascularization (
RR
, 0.81; 95%
CI
, 0.70–0.94), and stent thrombosis (
RR
, 0.57; 95%
CI
, 0.41–0.79) were all significantly lower using
IVUS
guidance.
Conclusions
Compared with standard
CA
‐guided
PCI
, the use of
IVUS
imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis.
