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Peer-reviewedCC BYJACC. Advances

Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions: A Meta-Analysis of Randomized Controlled Trials.

  • Mohammed A Elbahloul1
  • Bahaa El Deen Wehbeh2
  • Ahmed Samy Badran3
  • Hadeel Aboueisha4
  • Atef Akoum5
  • Ayman Elbadawi6
  • Emmanouil S Brilakis7
  • Fernando Alfonso8
  • Islam Y Elgendy9
9 affiliations
  1. 1Faculty of Medicine, Kafr El-Shaikh University, El-Shaikh, Egypt. Electronic address: https://twitter.com/MAElbahloul.
  2. 2Department of Internal Medicine, American University of Beirut University Medical Center, Beirut, Lebanon. Electronic address: https://twitter.com/BahaaWehbehMD.
  3. 3Faculty of Medicine, Ain-Shams University, Cairo, Egypt. Electronic address: https://twitter.com/ASBadranMD.
  4. 4Faculty 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: [email protected].
  5. 5Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA. Electronic address: https://twitter.com/A_Akoum96.
  6. 6Department of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA. Electronic address: https://twitter.com/Ayman_Elbadawi_.
  7. 7Division of Cardiovascular Medicine, Allina Health Heart & Vascular Surgery Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. Electronic address: https://twitter.com/esbrilakis.
  8. 8Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain.
  9. 9Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA. Electronic address: https://twitter.com/islamelgendy83.
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Abstract

Background

Intravascular imaging (IVI) guidance improves percutaneous coronary intervention (PCI) outcomes, yet recent randomized controlled trials (RCTs) challenged these findings.Objectives

This 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

The 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

Eighteen 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

IVI guidance reduces the risk of adverse events for complex lesions. The benefit was in part driven by achieving imaging-defined stent optimization.

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Cite

BibTeXRIS
BibTeX
@article{elbahloul2026intravascular,
  title = {{Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions: A Meta-Analysis of Randomized Controlled Trials.}},
  author = {Mohammed A Elbahloul and Bahaa El Deen Wehbeh and Ahmed Samy Badran and Hadeel Aboueisha and Atef Akoum and Ayman Elbadawi and Emmanouil S Brilakis and Fernando Alfonso and Islam Y Elgendy},
  journal = {JACC. Advances},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacadv.2026.103340},
  url = {https://europepmc.org/article/MED/42879937},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Intravascular Imaging-Guided Drug-Eluting Stenting for Complex Coronary Lesions: A Meta-Analysis of Randomized Controlled Trials.
AU  - Mohammed A Elbahloul
AU  - Bahaa El Deen Wehbeh
AU  - Ahmed Samy Badran
AU  - Hadeel Aboueisha
AU  - Atef Akoum
AU  - Ayman Elbadawi
AU  - Emmanouil S Brilakis
AU  - Fernando Alfonso
AU  - Islam Y Elgendy
PY  - 2026
DA  - 2026/10/15
JO  - JACC. Advances
DO  - 10.1016/j.jacadv.2026.103340
UR  - https://europepmc.org/article/MED/42879937
AB  - Background  Intravascular imaging (IVI) guidance improves percutaneous coronary intervention (PCI) outcomes, yet recent randomized controlled trials (RCTs) challenged these findings.Objectives  This 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  The 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  Eighteen 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  IVI guidance reduces the risk of adverse events for complex lesions. The benefit was in part driven by achieving imaging-defined stent optimization.
SN  - 2772-963X
ER  -