TCT-359 Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention for Bifurcation Lesions: A Systematic Review and Meta-Analysis

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Percutaneous coronary intervention (PCI) for bifurcation lesions remains a complex procedure associated with higher risks of restenosis and adverse events. The role of intravascular imaging (IVI)—intravascular ultrasound (IVUS) or optical coherence tomography (OCT)—in optimizing bifurcation PCI is increasingly recognized, but its comparative effectiveness versus angiography-guidance alone remains under investigation. Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies comparing IVI-guided versus angiography-guided PCI for bifurcation lesions. Outcomes assessed included major adverse cardiac events (MACE), target lesion failure (TLF), target vessel revascularization (TVR), and stent thrombosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted or calculated. Results: This meta-analysis included 12 studies with 13,742 patients undergoing PCI for bifurcation lesions (6,809 IVI-guided; 6,933 angiography-guided). Intravascular imaging guidance significantly reduced the risk of major adverse cardiac events (MACE) at 1 year (6.4% vs. 9.3%; HR: 0.68; 95% CI: 0.55–0.83; p < 0.001), target lesion failure (5.7% vs. 8.6%; HR: 0.71; p = 0.002), and target vessel revascularization (3.1% vs. 5.2%; HR: 0.61; p = 0.004). Stent thrombosis was significantly lower in the IVI-guided group (0.6% vs. 1.5%; HR: 0.43; p = 0.017), along with reduced all-cause mortality (2.9% vs. 4.1%; HR: 0.72; p = 0.031). Benefits were more pronounced in patients with left main bifurcation lesions and those treated with a two-stent strategy. Conclusion: Intravascular imaging-guided PCI is associated with significantly lower rates of MACE, TLF, TVR, and stent thrombosis compared with angiography-guided PCI in patients with coronary bifurcation lesions. These findings support the routine use of IVUS or OCT in complex bifurcation interventions, particularly in left main disease and when a two-stent strategy is employed. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B158

Last Page

B159

Comments

Transcatheter Cardiovascular Therapeutics held 2025-10-25 to 2025-10-28 in San Francisco, CA

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