{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:31:08Z","timestamp":1791405068986,"version":"4.3.3"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intravascular ultrasound (IVUS) has been increasingly used as an adjunctive tool for complex percutaneous interventions (PCIs); however, comparative randomized evidence with conventional angiography in unprotected left main coronary artery (ULMCA) disease remains scarce and fragmented. Therefore, this systematic review and meta\u2010analysis aimed to assess and synthesize evidence regarding its use in ULMCA disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic literature search across PubMed, Scopus, Web of Science, and Cochrane until April 2026 to identify relevant RCTs comparing IVUS\u2010guided PCI with conventional angiography\u2010guided PCI in ULMCA disease. Risk of bias of studies was assessed using the Cochrane RoB\u20102 tool. A random\u2010effects model meta\u2010analysis was performed in R, with an exploratory univariate meta\u2010regression of covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four randomized trials involving 2278 patients with ULMCA disease were included. Compared with angiography\u2010guided PCI, IVUS guidance was associated with numerically lower risks of all\u2010cause death, cardiac death, target lesion revascularization, and target vessel revascularization, while myocardial infarction and stent thrombosis were similar between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients undergoing PCI for ULMCA disease, IVUS guidance was associated with numerically favorable but statistically nonsignificant reductions in mortality and repeat revascularization, without clear differences in myocardial infarction or stent thrombosis. Although randomized evidence is still lacking to determine clinical superiority, these results justify powered future trials to determine whether the effects of IVUS guidance vary according to prior myocardial infarction status and left ventricular ejection fraction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70367","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:32:23Z","timestamp":1781091143000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["IVUS\u2010Guided Versus Angiography\u2010Guided PCI for Unprotected Left Main Coronary Artery Disease: A Systematic Review, Meta\u2010Analysis, and GRADE Assessment of Randomized Trials"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3315-4167","authenticated-orcid":false,"given":"Abdelrahman","family":"Elhakim","sequence":"first","affiliation":[{"name":"Department of cardiology and intensive care St\u00e4dtisches Klinikum Braunschweig Braunschweig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig\u2010Holstein Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3083-857X","authenticated-orcid":false,"given":"Mohammed A.","family":"Elbahloul","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kafr El\u2010Shaikh University Kafr El Shaikh Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3283-7219","authenticated-orcid":false,"given":"Abdelrahman M.","family":"Elettreby","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Mansoura University Mansoura 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University Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer Al","family":"Manla","sequence":"additional","affiliation":[{"name":"Evanglisches Herzzentrum Coswig Coswig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Bisht","sequence":"additional","affiliation":[{"name":"Evanglisches Herzzentrum Coswig Coswig 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