Clinical Effectiveness of IVUS-guided PCI vs Angiography- guided PCI: A Retrospective Two-Year Follow-Up Study from India

Abstract

Background: IVUS compared to angiography is associated with better vessel sizing, optimal stent selection and improved stent expansion, which has been associated with improved long-term outcomes, including reductions in mortality and target vessel failure (TVF). Despite these advantages, no long-term observational registries evaluating IVUS use have been reported from India or South Asia.
Methods: This was a retrospective observational cohort study conducted at a tertiary care centre in India. The institutional PCI registry was reviewed to identify all patients who underwent percutaneous coronary intervention between January 2022 and December 2023. A total of 809 patients were treated during this period, including 178 patients who received IVUS-guided PCI and 631 who received angiography-guided PCI. Of these, follow-up data were successfully obtained for 560 patients (69.2%), comprising 113 IVUS-guided and 447 angiography-guided cases. The remaining 249 patients (30.8%) were lost to follow-up. Clinical outcomes were assessed using standardized definitions. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, stent thrombosis, and in-stent restenosis. Secondary outcomes included symptom recurrence (angina and dyspnea). Relative risks (RR) and 95% confidence intervals (CI) were calculated, with statistical significance set at p < 0.05. Median follow-up duration was 2.6 years.
Results: Outcomes of 447 angiography-guided PCI and 113 IVUS-guided PCI patients were analyzed over a median follow-up of 2.6 years. IVUS-guided PCI was associated with a lower risk of major adverse cardiovascular events (MACE), showing a 23% relative risk reduction compared to the angiography group (RR = 0.77, 95% CI: 0.48–1.25, p = 0.27). There was a statistically significant reduction in stent thrombosis (RR = 0.40, 95% CI: 0.12–1.27, p = 0.05), and a 34% relative risk reduction in death was observed with IVUS-guided PCI (RR = 0.66, 95% CI: 0.23–1.86, p = 0.27).
Conclusion: IVUS-guided PCI was associated with numerically lower rates of stent thrombosis, mortality, and MACE compared with angiography-guided PCI; however, these differences did not reach statistical significance. These findings suggest a potential association but should be interpreted cautiously given the observational design and loss to follow-up.