{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T09:45:00Z","timestamp":1793785500328,"version":"4.6.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has improved outcomes in randomized trials, yet some recent European trials reported neutral results despite positive findings from East Asian studies. This study assessed whether benefit was consistent across settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Randomized trials comparing IVUS-guided with angiography-guided drug-eluting stent PCI were systematically reviewed and meta-analysed. Pooled risk ratios (RRs) used restricted maximum likelihood random-effects models with Hartung\u2013Knapp\u2013Sidik\u2013Jonkman adjustment. Geographic effect modification was pre-specified as the primary hypothesis, and the interaction test for cardiac death was the primary analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen trials (14 033 patients; 10 East Asian [10 155], 7 non-Asian [3878]) were included. The pooled RR for cardiac death was.71 (95% confidence interval [CI] .53\u2013.94, P\u2005=\u2005.022), with a significant geographic interaction: East Asian RR.56 (.46\u2013.69) vs non-Asian RR 1.23 (.85\u20131.76; interaction P\u2005&amp;lt;\u2005.001). Treatment effects diverged for target-vessel myocardial infarction (TV-MI; interaction P\u2005=\u2005.011), target-vessel revascularization (TVR; interaction P\u2005=\u2005.004), and major adverse cardiovascular events (MACE; interaction P\u2005=\u2005.040). IVUS guidance reduced definite stent thrombosis (RR .39, 95% CI .19\u2013.79; interaction P\u2005=\u2005.433). All-cause death was similar (RR .89, 95% CI .76\u20131.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Considering all studies, IVUS-guided PCI reduced cardiac death, TV-MI, TVR, MACE, and stent thrombosis. However, significant interactions were present such that the relative reductions in cardiac death, TV-MI, TVR, and MACE were greater in the Asian compared with non-Asian trials (although stent thrombosis was reduced consistently across geographies). Differences in how the information derived from IVUS was used to optimize stent implantation may contribute to this geographic heterogeneity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehag653","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:55:25Z","timestamp":1786017325000},"source":"Crossref","is-referenced-by-count":1,"title":["Geographic heterogeneity in outcomes of intravascular ultrasound-guided vs angiography-guided percutaneous coronary intervention: a meta-analysis of randomized trials"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1985-1783","authenticated-orcid":false,"given":"Heerajnarain","family":"Bulluck","sequence":"first","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Clarendon Way, Leeds LS2 9JT ,","place":["UK"]},{"name":"Beacon Hospital Department of Cardiology, , Bracken Road, Sandyford, Dublin D18 AK68 ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3859-7809","authenticated-orcid":false,"given":"Mohammad","family":"Haris","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartik","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdelgader","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Wahab","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Bate","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]},{"name":"College of Health, Adelaide University , Adelaide ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1134-3036","authenticated-orcid":false,"given":"Arka","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Clarendon Way, Leeds LS2 9JT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026090309420208400_ehag653-B1","doi-asserted-by":"publisher","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur Heart J"},{"key":"2026090309420208400_ehag653-B2","doi-asserted-by":"publisher","first-page":"e771","DOI":"10.1161\/CIR.0000000000001328","article-title":"2025 ACC\/AHA\/ACEP\/NAEMSP\/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"151","author":"Rao","year":"2025","journal-title":"Circulation"},{"key":"2026090309420208400_ehag653-B3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.ahj.2012.09.017","article-title":"A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial","volume":"165","author":"Chieffo","year":"2013","journal-title":"Am Heart J"},{"key":"2026090309420208400_ehag653-B4","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.jcin.2012.11.009","article-title":"Randomized comparison of clinical outcomes between intravascular ultrasound and angiography-guided drug-eluting stent implantation for long coronary artery stenoses","volume":"6","author":"Kim","year":"2013","journal-title":"JACC Cardiovasc Interv"},{"key":"2026090309420208400_ehag653-B5","doi-asserted-by":"publisher","first-page":"e002592","DOI":"10.1161\/CIRCINTERVENTIONS.115.002592","article-title":"Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study","volume":"8","author":"Kim","year":"2015","journal-title":"Circ Cardiovasc Interv"},{"key":"2026090309420208400_ehag653-B6","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1001\/jama.2015.15454","article-title":"Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial","volume":"314","author":"Hong","year":"2015","journal-title":"JAMA"},{"key":"2026090309420208400_ehag653-B7","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.jcin.2020.10.001","article-title":"3-year outcomes of the ULTIMATE trial comparing intravascular ultrasound versus angiography-guided drug-eluting stent implantation","volume":"14","author":"Gao","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2026090309420208400_ehag653-B8","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.4244\/EIJV10I12A245","article-title":"Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results of a randomised, single-centre, single-blind trial","volume":"10","author":"Tian","year":"2015","journal-title":"EuroIntervention"},{"key":"2026090309420208400_ehag653-B9","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.jcin.2013.09.013","article-title":"Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis","volume":"7","author":"Jang","year":"2014","journal-title":"JACC Cardiovasc Interv"},{"key":"2026090309420208400_ehag653-B10","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.ahj.2016.10.008","article-title":"Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: meta-analysis of randomized trials","volume":"185","author":"Bavishi","year":"2017","journal-title":"Am Heart J"},{"key":"2026090309420208400_ehag653-B11","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/S0140-6736(23)02454-6","article-title":"Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis","volume":"403","author":"Stone","year":"2024","journal-title":"Lancet"},{"key":"2026090309420208400_ehag653-B12","doi-asserted-by":"publisher","first-page":"2200","DOI":"10.1056\/NEJMoa2601521","article-title":"Intravascular ultrasound-guided or angiography-guided complex high-risk PCI","volume":"394","author":"Diletti","year":"2026","journal-title":"N Engl J Med"},{"key":"2026090309420208400_ehag653-B13","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1056\/NEJMoa2600440","article-title":"IVUS-guided versus angiography-guided PCI in unprotected left main coronary disease","volume":"394","author":"Testa","year":"2026","journal-title":"N Engl J Med"},{"key":"2026090309420208400_ehag653-B14","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1016\/j.jacc.2026.01.035","article-title":"Intravascular imaging- vs angiography-guided complex PCI: 5-year outcomes from a randomised trial (RENOVATE-COMPLEX-PCI)","volume":"87","author":"Lee","year":"2026","journal-title":"J Am Coll Cardiol"},{"key":"2026090309420208400_ehag653-B15","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1016\/S0140-6736(24)00282-4","article-title":"Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial","volume":"403","author":"Li","year":"2024","journal-title":"Lancet"},{"key":"2026090309420208400_ehag653-B16","doi-asserted-by":"publisher","first-page":"2080","DOI":"10.1016\/j.jacc.2026.01.081","article-title":"IVUS or angiography guidance for percutaneous coronary intervention in complex coronary bifurcation lesions: the DKCRUSH VIII randomized clinical trial","volume":"87","author":"Gao","year":"2026","journal-title":"J Am Coll Cardiol"},{"key":"2026090309420208400_ehag653-B17","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1136\/bmj.326.7382.219","article-title":"Interaction revisited: the difference between two estimates","volume":"326","author":"Altman","year":"2003","journal-title":"BMJ"},{"key":"2026090309420208400_ehag653-B18","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026090309420208400_ehag653-B19","doi-asserted-by":"publisher","first-page":"2618","DOI":"10.1016\/S0140-6736(16)31922-5","article-title":"Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial","volume":"388","author":"Ali","year":"2016","journal-title":"Lancet"},{"key":"2026090309420208400_ehag653-B20","doi-asserted-by":"publisher","first-page":"e009452","DOI":"10.1161\/CIRCINTERVENTIONS.121.011004","article-title":"Optical coherence tomography versus intravascular ultrasound and angiography-guided strategy to reduce procedural complications during stent implantation: the iSIGHT randomised trial","volume":"14","author":"Chami\u00e9","year":"2021","journal-title":"Circ Cardiovasc Interv"},{"key":"2026090309420208400_ehag653-B21","doi-asserted-by":"publisher","first-page":"83","DOI":"10.14744\/AnatolJCardiol.2018.21447","article-title":"Intravascular ultrasound-guided drug-eluting stent implantation for patients with unprotected left main coronary artery lesions: a single-centre randomised trial","volume":"21","author":"Liu","year":"2019","journal-title":"Anatol J Cardiol"},{"key":"2026090309420208400_ehag653-B22","doi-asserted-by":"publisher","first-page":"3875","DOI":"10.1002\/sim.1009","article-title":"A refined method for the meta-analysis of controlled clinical trials with binary outcome","volume":"20","author":"Hartung","year":"2001","journal-title":"Stat Med"},{"key":"2026090309420208400_ehag653-B23","doi-asserted-by":"publisher","first-page":"3153","DOI":"10.1002\/sim.1262","article-title":"A simple confidence interval for meta-analysis","volume":"21","author":"Sidik","year":"2002","journal-title":"Stat Med"},{"key":"2026090309420208400_ehag653-B24","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1471-2288-14-25","article-title":"The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-laird method","volume":"14","author":"IntHout","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2026090309420208400_ehag653-B25","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1002\/sim.2528","article-title":"Much ado about nothing: a comparison of the performance of meta-analytical methods with rare events","volume":"26","author":"Bradburn","year":"2007","journal-title":"Stat Med"},{"key":"2026090309420208400_ehag653-B26","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/S0033-0620(85)80003-7","article-title":"Beta blockade during and after myocardial infarction: an overview of the randomized trials","volume":"27","author":"Yusuf","year":"1985","journal-title":"Prog Cardiovasc Dis"},{"key":"2026090309420208400_ehag653-B27","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1007\/s11606-019-04925-8","article-title":"Real-world performance of meta-analysis methods for double-zero-event studies with dichotomous outcomes using the Cochrane database of systematic reviews","volume":"34","author":"Ren","year":"2019","journal-title":"J Gen Intern Med"},{"key":"2026090309420208400_ehag653-B28","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"2026090309420208400_ehag653-B29","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"BMJ"},{"key":"2026090309420208400_ehag653-B30","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5 (Updated August 2024)","author":"Page","year":"2024"},{"key":"2026090309420208400_ehag653-B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J Stat Softw"},{"key":"2026090309420208400_ehag653-B32","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1097\/MCA.0000000000001356","article-title":"Intravascular ultrasound-guided percutaneous coronary intervention for patients with unprotected left main coronary artery lesions","volume":"35","author":"Bendary","year":"2024","journal-title":"Coron Artery Dis"},{"key":"2026090309420208400_ehag653-B33","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1002\/ccd.31352","article-title":"Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention: an updated meta-analysis of randomized clinical trials","volume":"105","author":"Ahmed","year":"2025","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026090309420208400_ehag653-B34","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/S0140-6736(24)01454-5","article-title":"Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention for patients with complex lesions (OCCUPI): an investigator-initiated, multicentre, randomised, open-label, superiority trial in South Korea","volume":"404","author":"Hong","year":"2024","journal-title":"Lancet"},{"key":"2026090309420208400_ehag653-B35","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1056\/NEJMoa2305861","article-title":"Optical coherence tomography-guided versus angiography-guided PCI","volume":"389","author":"Ali","year":"2023","journal-title":"N Engl J Med"},{"key":"2026090309420208400_ehag653-B36","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1056\/NEJMoa2307770","article-title":"OCT or angiography guidance for PCI in complex bifurcation lesions","volume":"389","author":"Holm","year":"2023","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/advance-article-pdf\/doi\/10.1093\/eurheartj\/ehag653\/70942815\/ehag653.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/advance-article-pdf\/doi\/10.1093\/eurheartj\/ehag653\/70942815\/ehag653.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:42:25Z","timestamp":1788442945000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/advance-article\/doi\/10.1093\/eurheartj\/ehag653\/8781142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":36,"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehag653","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"ehag653"}}