Early and Long-Term Outcome of Intravascular Ultrasonography-Guided Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: A Network Meta-Analysis
Gusti Ngurah Prana Jagannatha1, Nikita Toding Labi2, Ketut Angga Aditya Putra Pramana3, Yusra Pintaningrum3
Faculty of Medicine, Udayana University, Indonesia1, Sam Ratulangi University, Indonesia2, University of Mataram, Indonesia3
Several studies have shown that intravascular ultrasonography (IVUS) guidance provide a good long-term outcome in patients with acute myocardial infarction. However, because IVUS use is associated with delay in revascularization time, the addition of IVUS in primary percutaneous coronary intervention (PPCI) of ST-elevation myocardial infarction (STEMI) patients is still unclear regarding the benefit.
We performed a systematic search in databases (PubMed, ScienceDirect, ProQuest, and Cochrane Library) for studies comparing IVUS-guided and angiography-guided PPCI in STEMI. Review Manager 5.4 was utilized to compute the summary of odds ratios (OR), mean differences (MD), and 95% CI for the outcomes. Our outcomes of interest are all-cause mortality, cardiovascular death, early and long-term major adverse cardiovascular events (MACE), in-hospital mortality, in-stent restenosis (ISR), target vessel revascularization (TVR), door-to-baloon time <
90 minutes, length of stay, and cost.
The addition of IVUS in PPCI of STEMI patients was associated with significant reduction of all cause mortality and MACE compared with angiography only guidance. Door-to-balloon time optimization has the potential to provide a desirable outcomes for STEMI patients with this strategy.