Background: Intravascular ultrasound ( IVUS ) guidance during percutaneous coronary intervention ( PCI ) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of PCI . However, the long‐term beneficial effect of IVUS over PCI guided by coronary angiography ( CA ) alone remains under question. We sought to investigate the outcomes of IVUS ‐guided compared with CA ‐guided PCI . Methods and Results: We performed a comprehensive search of PubMed, Medline, and Cochrane Central Register, looking for randomized controlled trials and observational studies that compared PCI outcomes of IVUS with CA . Data were aggregated for the primary outcome measure using the random‐effects model as pooled risk ratio ( RR ). The primary outcomes were the rate of cardiovascular death, need for target lesion revascularization, occurrence of myocardial infarction, and rate of stent thrombosis. A total of 19 studies met the inclusion criteria, comprising 27 610 patients divided into IVUS (n=11 513) and CA (n=16 097). Compared with standard CA ‐guided PCI , we found that the risks of cardiovascular death ( RR , 0.63; 95% CI , 0.54–0.73), myocardial infarction ( RR , 0.71; 95% CI , 0.58–0.86), target lesion revascularization ( RR , 0.81; 95% CI , 0.70–0.94), and stent thrombosis ( RR , 0.57; 95% CI , 0.41–0.79) were all significantly lower using IVUS guidance. Conclusions: Compared with standard CA ‐guided PCI , the use of IVUS imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis.

Diagnosis and management challenges of in-stent restenosis in coronary arteries

The clinical impact of the influenza vaccination on cardiovascular outcomes in people with established cardiovascular disease (CVD) is still debated. The aim of this meta-analysis was to estimate the effect of influenza vaccination on cardiovascular and cerebrovascular outcomes among patients with established CVD. We systematically searched all electronic databases from inception until 15 April 2022. Primary clinical outcomes were all-cause mortality (ACM), and major adverse clinical events (MACE). Secondary endpoints were heart failure, myocardial infarction, CV mortality, and stroke. Eighteen articles (five randomized trials and thirteen observational studies), with a total of 22,532,165 patients were included in the analysis. There were 217,072 participants included in the high cardiovascular risk or established CVD population (vaccinated n = 111,073 and unvaccinated n = 105,999). The mean age of the patients was 68 years old, without any difference between groups (69 vs 71) years. At mean follow-up of 1.5 years, vaccinated group was associated with lower risk for all-cause mortality [HR, 0.71(95%CI, 0.63-0.80), p < 0.001], MACE [HR, 0.83(95%CI:0.72-0.96), p = 0.01], CV mortality [HR, 0.78(95%CI:0.68-0.90), p < 0.001] and myocardial infarction [HR, 0.82(95%CI:0.74-0.92), p < 0.001] compared to unvaccinated group. While incidence of stroke [HR, 1.03 (95%CI, 0.92-1.06), p = 0.61] and heart failure [HR, 0.74 (95%CI, 0.51-1.08), p = 0.12] did not differ between the two groups. Influenza vaccination reduced major adverse clinical events, all-cause mortality, CV mortality and myocardial infarction. These highlighted the importance of influenza vaccination in established CVD or high cardiovascular risk. Cardioprotective effect of Influenza vaccine among patients with established cardiovascular disease or at high rish with a significant reduction in mortality and adverse cardiovascular outcomes.