Intravascular imaging vs. angiography alone to guide percutaneous coronary intervention in older adults: a meta-analysis of randomized controlled trials
Author Department
Medicine; Cardiology
Document Type
Article, Peer-reviewed
Publication Date
10-2025
Abstract
Background: Older adults undergoing percutaneous coronary intervention (PCI) face unique challenges due to complex anatomy and comorbidities. Intravascular imaging [including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] has been shown to improve PCI outcomes, but its benefits in older adults are less well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare intravascular imaging with angiography alone to guide PCI in older adults.
Methods: Cochrane, PubMed, and Scopus were searched for RCTs comparing intravascular imaging (IVUS or OCT) vs. angiography alone in adults aged ≥65 years. The outcome of interest was major adverse cardiovascular events (MACE) at the longest follow-up, as defined by each trial. Subgroup analyses were performed based on intravascular imaging modality, age group, and lesion complexity. Data were pooled using random-effects models, and heterogeneity was assessed using Higgins' I² statistic.
Results: Nine RCTs (n = 7164, intravascular imaging = 3703, angiography alone = 3461) met the inclusion criteria. Intravascular imaging significantly reduced MACE compared with angiography alone [relative risk (RR) 0.66, 95% confidence interval (CI) 0.56-0.77; P < 0.001; I² = 0%]. IVUS demonstrated superiority over angiography alone (RR 0.55, 95% CI 0.43-0.72; P < 0.001; I² = 0%), while OCT demonstrated only a trend toward MACE reduction (RR 0.80, 95% CI 0.62-1.02). Subgroup analyses indicated consistent benefits with intravascular imaging for adults aged ≥65 and ≥70 years, respectively, and among those with complex coronary lesions (RR 0.65, 95% CI 0.53-0.79; P < 0.001).
Conclusion: Intravascular imaging guidance, especially IVUS, reduces MACE in older adults undergoing PCI compared with angiography alone.
Keywords: angiography; coronary artery disease; intravascular imaging; intravascular ultrasound; older; optical coherence tomography; percutaneous coronary intervention.
Recommended Citation
Ezenna C, Ibrahim S, Ismayl M, Murali Krishna M, Chi KY, Joseph M, Akman Z, Rossi R, Nouri A, Al Mouslmani M, Damluji A, Goldsweig AM, Nanna MG. Intravascular imaging vs. angiography alone to guide percutaneous coronary intervention in older adults: a meta-analysis of randomized controlled trials. Coron Artery Dis. 2025 Oct 30. doi: 10.1097/MCA.0000000000001584. Epub ahead of print.
PMID
41176629