Efficacy of intravascular ultrasound-guided primary percutaneous coronary intervention in acute coronary syndrome - a meta-analysis of randomized controlled trials with meta-regression

Sep 29, 2026

Acute coronary syndrome (ACS) is managed with primary percutaneous coronary intervention (PCI), and intravascular ultrasound (IVUS) may improve stent placement accuracy. This systematic review and meta-analysis follows PRISMA to synthesize randomized controlled trials comparing IVUS-guided PCI with non-IVUS-guided PCI in ACS patients. Nine RCTs (11,843 participants) were pooled with random-effects models, evaluating TLR, TVF, post-procedural MI, stent thrombosis, MACE, and all-cause mortality. IVUS-guided PCI significantly lowers TLR, TVF, and post-procedural MI, with non-significant differences for MACE and all-cause mortality.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Introduction

Coronary angiography limitations

Role of intravascular imaging (IVUS, OCT)

Methods

Literature search and PRISMA approach

Included trials and patient numbers

Outcomes and statistical analysis

Results

Effects on TLR, TVF, and post-procedural MI

Stent thrombosis, MACE, and all-cause mortality

Conclusion

Systematic Review/Meta-analysis Efficacy of intravascular ultrasound-guided primary percutaneous coronary intervention in acute coronary syndrome: a meta-analysis of randomized controlled trials with meta-regression Ibrahim Khalil, MBBSa ,*, Md. Imran Hossain, MBBSb , Sajjad Ghanim Al-Badri, MBChBc , Mohd Turzo Rahman, MDd , Lota Halder, MBBSe , M. Rafiqul Islam, MBBSf, Sunjida Amin Promi, MBBSg , Arindam Das Joy, MBBSa , Md Abu Sayed, MBBSg , Mahmuda Akter, MBBSb Background: Acute coronary syndrome (ACS) is effectively managed with primary percutaneous coronary intervention (PCI), enhanced by intravascular ultrasound (IVUS) for precise stent placement. This meta-analysis evaluates the efficacy and safety of IVUS-guided PCI compared to non-IVUS-guided PCI (e.g. , angiography or optical coherence tomography) in ACS patients. Methods: Following PRISMA guidelines, we searched PubMed, Embase, Cochrane CENTRAL, and [ClinicalTrials.gov](ClinicalTrials.gov) for randomized controlled trials (RCTs) from January 2014 to August 2024 comparing IVUS-guided PCI with non-IVUS-guided PCI in ACS patients. Nine RCTs involving 11 843 patients (6230 IVUS and 5613 non-IVUS) were included. Outcomes included target lesion revascularization (TLR), target vessel failure (TVF), post-procedural myocardial infarction (MI), stent thrombosis, major adverse cardiac events (MACE), and all-cause mortality. Data were pooled using a random-effects model, with risk ratios (RRs) and 95% confidence intervals (CIs) calculated. Heterogeneity was assessed via I2 statistics, and meta-regression explored study-level influences. Results: IVUS-guided PCI significantly reduced TLR (RR 0.62, 95% CI 0.48–0.80, P = 0.0002, I2 = 0%), TVF (RR 0.71, 95% CI 0.57–0.89, P = 0.003, I2 = 22%), and post-procedural MI (RR 0.72, 95% CI 0.60–0.87, P = 0.0005, I2 = 0%) . Stent thrombosis showed a non-significant reduction (RR 0 .62, 95% CI 0 .34–1. 12, P = 0. 11, I2 = 2%) . MACE (RR 0 .87, 95% CI 0 .67–1. 11, P = 0.26, I2 = 63%) and all-cause mortality (RR 0.91, 95% CI 0.66–1.26, P = 0.57, I2 = 22%) were not significantly different. Conclusion: IVUS-guided PCI significantly lowers risks of TLR, TVF, and post-procedural MI in ACS patients, with a trend toward reduced MACE, supporting its use for improved PCI outcomes. Keywords: acute coronary syndrome, coronary angiography, intravascular ultrasound, meta-analysis, percutaneous coronary intervention Introduction Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide. Percutaneous coronary intervention (PCI) has emerged as a fundamental therapeutic aInternal Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh, bManikganj Medical College and Hospital, Manikganj, Bangladesh, cCollege of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq, dInternal Medicine, Flushing Hospital Medical Center, Flushing, NY, USA, eInternational School of Medicine, International University of Kyrgyzstan, Bishkek, Kyrgyzstan, fShaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh and gChattogram Medical College, Chattogram, Bangladesh Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Internal Medicine, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh. E-mail: [ibrahim124904@gmail.com](ibrahim124904@gmail.com) (I. Khalil). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:685–697 Received 20 April 2025; Accepted 16 October 2025 Published online 28 October 2025 [http://dx.doi.org/10.1097

FAQs

What question does the meta-analysis address?

Whether IVUS-guided primary PCI improves efficacy and safety compared with non-IVUS-guided PCI in patients with acute coronary syndrome.

How were eligible studies selected and how many trials were included?

Following PRISMA, randomized controlled trials comparing IVUS-guided versus non-IVUS-guided PCI were searched in PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov. Nine RCTs totaling 11,843 patients were included.

Which clinical outcomes improved with IVUS-guided PCI?

IVUS-guided PCI significantly reduced target lesion revascularization, target vessel failure, and post-procedural myocardial infarction. Differences in MACE and all-cause mortality were not statistically significant.

Sep 29, 2026

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