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Interventions of the left main coronary artery are complex and require high degree of technical skills. Intravascular ultrasound (IVUS) can aid interventions of the left main coronary artery. We performed this meta-analysis to assess the efficacy of use of IVUS compared to angiographic-guided PCI.
Electronic search of PubMed, EBSCO and Google Scholar databases was done to identify studies of IVUS guided left main interventions. Pooled meta-analysis of major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR) and stent thrombosis was performed using Comprehensive Meta-analysis 2 software. Mantel-Haenszel random effects model was used to compute the odds ratio (OR) for the above outcomes with and without the use of IVUS.
A total of 4 studies with 2607 patients were identified that compared left main interventions done using with and without IVUS guidance. Interventions were done using IVUS in 1576 and angiographic-guided interventions were performed in 1031 patients. The risk of MACE with the use of IVUS guided intervention was 0.64 (95% CI: 0.49 - 0.83). The use of IVUS decreased cardiovascular death (OR 0.37; 95% CI: 0.23 -0.6) and MI (OR 0.69; 95% CI: 0.51 - 0.92). IVUS use in left main intervention had a trend towards lower TVR (OR 0.66; 95% CI: 0.27 - 2.49), TLR (OR 0.74; 95% CI 0.5 - 1.09) and stent thrombosis (OR 0.26; 0.07 - 1.04).
The use of IVUS for left main interventions is associated with 36% lower risk of MACE, 31% lower risk of repeat MI and 63% lower risk of cardiovascular death. The above findings suggest major outcomes benefit with the use of IVUS for left main interventions.