Low-contrast intravascular ultrasonography-guided percutaneous coronary intervention for contrast-associated acute kidney injury prevention in chronic kidney disease: a meta-analysis
P Pajareya, J Kaewsrihawong, W Chuanchai, T Sakpetch, S Phutinart, N SiranartAbstract
Background
Imaging-guided percutaneous coronary intervention (PCI), including intravascular ultrasonography (IVUS) and optical coherence tomography (OCT), has emerged as an alternative to standard coronary angiography (CAG)-guided PCI. However, evidence regarding the safety of low-dose imaging-guided PCI in reducing contrast-associated acute kidney injury (CA-AKI) in patients with chronic kidney disease (CKD) remains limited.
Purpose
To evaluate the safety and efficacy of low-contrast IVUS-guided PCI (IVUS-low), low-contrast OCT-guided PCI (OCT-low), standard-contrast IVUS-guided PCI (IVUS-std), and standard-contrast OCT-guided PCI (OCT-std), compared with conventional CAG-guided PCI (CAG-std).
Method
A literature search was conducted in PubMed, Scopus, and the Cochrane Library from their inception through January 2026. Patients with CKD undergoing PCI were included. The primary endpoint was the incidence of CA-AKI. The secondary endpoints included major adverse cardiac events (MACE), myocardial infarction (MI), cardiovascular (CV) mortality, and all-cause mortality.
Results
A total of 6 studies comprising 7,182 patients (4,621females [64.3%]; mean age 68.1 ± 10.6 years) were included. The IVUS-low group demonstrated a significant reduction in CA-AKI incidence compared with the IVUS-std group (OR 0.21, 95% CI 0.05–0.92, p = 0.039) and the CAG-std group (OR 0.25, 95% CI 0.07–0.87, p = 0.030), with the highest P-score of 0.89. Although the IVUS-low group showed significantly higher all-cause mortality than the OCT-std group (OR 2.98, 95% CI 1.10–8.10, p = 0.032), its efficacy in reducing MACE, MI, and CV mortality was comparable to that of the IVUS-std, OCT-std, and CAG-std groups. Compared with the CAG-std group, both the IVUS-std and OCT-std groups demonstrated significant reductions in MACE, CV mortality, and all-cause mortality, with more favorable P-scores.
Conclusions
Low-contrast IVUS-guided PCI may help reduce the incidence of CA-AKI in patients with CKD, with comparable rates of MACE, MI, and CV mortality to standard-contrast imaging-guided PCI (either IVUS or OCT) and conventional CAG-guided PCI.Figure 2For image description, please refer to the figure legend and surrounding text.Figure 1For image description, please refer to the figure legend and surrounding text.