Intracoronary Imaging-Guided Revascularization for Non-Culprit Lesions in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease

Seung, Jaeho; Choo, Eun Ho; Choi, Ik Jun; Lim, Sung Min; Moon, Dong Eon; Lee, Kwan Yong; Oh, Gyu Chul; Hwang, Byung‐Hee; Choi, Yun Seok; Park, Hun‐Jun; Chang, Kiyuk

doi:10.54912/jci.2023.0003

Cited by 1 publication

(1 citation statement)

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“…First, in ACS, non-culprit lesions often present vulnerability characteristics explaining the increased rates of non-culprit related events in these patients due to the patient's higher burden of cardiovascular risk factors and coronary inflammation [41]. Secondly, there is a paucity of data regarding physiology indices PCI guidance in acute coronary syndromes, especially for STEMI patients; the microcirculation and vascular bed modifications occurring during an ACS might alter the functional evaluations [42]. Even if other studies [43] already demonstrated the favorable outcomes in imaging-guided PCI along with an increased use [44] of intravascular imaging in acute patients, in our analysis, the percentage of ACS was not a significant moderator for TVR and MACE between the two groups: this might be explained for the different imaging modality used in the included manuscripts (OCT and IVUS might have proper advantages and disadvantages) or for the insufficiency of data available from all the studies to draw definite conclusions.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Imaging and Physiology in Guiding Coronary Revascularization: A Meta-Analysis

Improta,

Di Pietro,

Giansanti

et al. 2024

JCM

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Background: Percutaneous coronary intervention (PCI) is a widely used revascularization strategy for coronary artery disease. The choice between imaging-guided and physiology-guided PCI has been a subject of debate. This meta-analysis aims to systematically compare outcomes between imaging and physiology-guided PCI and management of intermediate coronary lesions (ICLs). Methods: A comprehensive literature search was conducted across major databases for studies published up to December 2023 following PRISMA guidelines. Seven eligible studies comparing imaging-guided and physiology-guided PCI were selected for the final analysis. Relevant outcome measures included major adverse cardiovascular events (MACE), target vessel revascularization (TVR), target vessel failure (TVF), and target lesion revascularization (TLR). Subgroup analysis was performed for ICLs. Results: A total of 5701 patients were included in the meta-analysis. After a mean follow-up of 2.1 years, imaging-guided PCI was associated with lower rates of TVR compared to physiology-guided PCI (OR 0.70, 95% CI 0.52–0.95, p = 0.02); concerning MACE, TVF, and TLR, no differences were found. When the analysis was restricted to studies considering ICLs management, there were no differences between the two techniques. Meta regression analysis did not show any impact of acute coronary syndromes (ACS) presentation on MACE and TVR. Conclusions: The findings suggest that imaging-guided PCI may reduce the need for future revascularization of the target vessel compared to the functional-guided approach, and this result was not influenced by ACS presentation. These results may have important implications for clinical practice, guiding interventional cardiologists in selecting the most appropriate guidance strategy.

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