{
  "abstract": "Background\n\nIntravascular imaging (IVI) guidance improves percutaneous coronary intervention (PCI) outcomes, yet recent randomized controlled trials (RCTs) challenged these findings.Objectives\n\nThis study aimed to evaluate the efficacy and safety of IVI-guided vs angiography-guided PCI in complex coronary lesions, incorporating recent large-scale trials with divergent findings.Methods\n\nThe authors conducted a meta-analysis of RCTs evaluating IVI-guided vs angiography-guided PCI among patients with complex coronary lesions. The primary outcomes were major adverse cardiovascular events (MACE) and cardiac death. Pooled risk ratios (RRs) with 95% CIs were calculated using frequentist random-effects models and complementary Bayesian analyses. The analysis was complemented by several sensitivity and subgroup analyses.Results\n\nEighteen RCTs enrolling 18,975 patients were included. IVI guidance was associated with significant reductions in MACE (RR: 0.67; 95% CI: 0.55-0.83), cardiac death (RR: 0.72; 95% CI: 0.53-0.97), myocardial infarction (RR: 0.87; 95% CI: 0.76-0.998), clinically driven target lesion revascularization (RR: 0.72; 95% CI: 0.51-0.999), and stent thrombosis (RR: 0.52; 95% CI: 0.35-0.78). A significant geographic interaction was identified for MACE, with benefit predominantly driven by Asian trial populations (Pinteraction < 0.01). In subgroup analysis, patients achieving imaging-defined stent optimization were associated with lower event rates than those who did not (RR: 0.41; 95% CI: 0.26-0.62).Conclusions\n\nIVI guidance reduces the risk of adverse events for complex lesions. The benefit was in part driven by achieving imaging-defined stent optimization.",
  "abstract_shown": true,
  "affiliations": [
    "Faculty of Medicine, Kafr El-Shaikh University, El-Shaikh, Egypt. Electronic address: https://twitter.com/MAElbahloul.",
    "Department of Internal Medicine, American University of Beirut University Medical Center, Beirut, Lebanon. Electronic address: https://twitter.com/BahaaWehbehMD.",
    "Faculty of Medicine, Ain-Shams University, Cairo, Egypt. Electronic address: https://twitter.com/ASBadranMD.",
    "Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. Electronic address: h.aboueisha@umcg.nl.",
    "Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA. Electronic address: https://twitter.com/A_Akoum96.",
    "Department of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA. Electronic address: https://twitter.com/Ayman_Elbadawi_.",
    "Division of Cardiovascular Medicine, Allina Health Heart & Vascular Surgery Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. Electronic address: https://twitter.com/esbrilakis.",
    "Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain.",
    "Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA. Electronic address: https://twitter.com/islamelgendy83."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Mohammed A Elbahloul"
    },
    {
      "affs": [
        1
      ],
      "name": "Bahaa El Deen Wehbeh"
    },
    {
      "affs": [
        2
      ],
      "name": "Ahmed Samy Badran"
    },
    {
      "affs": [
        3
      ],
      "name": "Hadeel Aboueisha"
    },
    {
      "affs": [
        4
      ],
      "name": "Atef Akoum"
    },
    {
      "affs": [
        5
      ],
      "name": "Ayman Elbadawi"
    },
    {
      "affs": [
        6
      ],
      "name": "Emmanouil S Brilakis"
    },
    {
      "affs": [
        7
      ],
      "name": "Fernando Alfonso"
    },
    {
      "affs": [
        8
      ],
      "name": "Islam Y Elgendy",
      "orcid": "0000-0001-9853-7591"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dvefvrb1bx16h.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jacadv.2026.103340",
  "fulltext_url": "https://europepmc.org/articles/PMC13694947",
  "id": "dvefvrb1bx16h",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42879937",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Coronary Interventions and Diagnostics"
    ]
  ],
  "openalex": "W7222296438",
  "pdf_url": "https://europepmc.org/articles/PMC13694947?pdf=render",
  "pmcid": "PMC13694947",
  "pmid": "42879937",
  "published": "2026-10-15",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dvefvrb1bx16h.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:46Z",
      "native_id": "MED:42879937",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42879937"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Coronary Interventions and Diagnostics",
      "subfield": "surgery"
    }
  ],
  "title": "Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions: A Meta-Analysis of Randomized Controlled Trials.",
  "title_text": "Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions: A Meta-Analysis of Randomized Controlled Trials.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:46Z",
  "url": "https://research.draconitic.com/paper/dvefvrb1bx16h",
  "venue": "JACC. Advances",
  "versions": []
}