A new network analysis adds yet more evidence that PCI performed with angiography alone is inferior to procedures performed either with adjunctive intravascular imaging or invasive functional tests. The meta-analysis, which included 32 randomized, controlled trials with more than 22,600 patients, showed that functionally guided PCI with primarily fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), as well as intravascular imaging using IVUS or optical coherence tomography (OCT), outperformed angiography-guided PCI alone for reducing MACE over follow-up ranging from 6 months to 5 years. Currently, functional testing with FFR or iFR is a class 1 recommendation to help guide decisions around PCI, while use of IVUS is a class 2a recommendation to help reduce the risk of ischemic events in left main CAD or complex coronary lesions, with optical coherence tomography (OCT) considered a reasonable alternative to IVUS. Continue reading
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