Introduction: Advanced chronic kidney disease (CKD) patients undergoing percutaneous coronary intervention (PCI) face a high risk of renal injury. Given this vulnerability, zero- and ultra-low-contrast PCI techniques have been proposed to minimize renal damage while still enabling effective revascularization. On this basis, this meta-analysis tests whether these contrast-sparing strategies yield better clinical and renal outcomes compared with conventional PCI in CKD patients. Methods: A total of 3939 records were retrieved from PubMed, Embase, Scopus, ScienceDirect, and Cochrane from inception till November 2025. Eligible RCTs and comparative observational studies reporting renal or cardiovascular outcomes were included. Pooled analyses were conducted in RevMan Web using a random-effects model with p < 0.05 considered statistically significant. Results: Across nine included studies (464,815 patients) evaluating zero-contrast or ultra-low-contrast PCI versus conventional PCI, zero-contrast PCI significantly reduced contrast-induced acute kidney injury (CI-AKI) (OR 0.24, 95% CI 0.12–0.49; p = 0.002), decreased contrast volume (MD −110 mL, 95% CI −168.6 to −51.8; p = 0.005), lowered the need for repeat revascularization (OR 0.26, 95% CI 0.09–0.77; p = 0.005), and reduced the incidence of emergent hemodialysis (OR 0.25, 95% CI 0.13–0.49; p < 0.0001). All-cause mortality and repeat myocardial infarction were initially nonsignificant but became significant after excluding outlier studies (OR 0.49, 95% CI 0.47–0.51; p < 0.00001; OR 0.19, 95% CI 0.10–0.35; p = 0.007, respectively). No significant differences were observed for major adverse cardiovascular events, cardiovascular or non-cardiovascular mortality, renal replacement therapy, or dialysis requirement. Conclusions: Our findings demonstrate that zero- and ultra-low-contrast PCI significantly reduces the risk of CI-AKI while preserving cardiovascular and renal outcomes, supporting its use as a safe and effective alternative to conventional PCI in high-risk CKD patients.

Ischemic heart disease is the leading global cause of death and frequently progresses to ischemic heart failure (IHF) after myocardial infarction through adverse left ventricular (LV)remodeling. Surgical LV restoration improves ventricular geometry and function but is limited by invasiveness and inconsistent outcomes. Transcatheter Left Ventricular Restoration (TLVR) has emerged as a minimally invasive alternative,employing devices such as Revivent TC, AccuCinch, and Parachute to reduce LV volume, wall stress, and improve LV ejection fraction (LVEF). While several studies have reported promising results, no prior meta‐analysis has synthesized the evidence across devices. This meta‐analysis followed PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Cochrane Library were searched through July 2025. Eligible studies included adult patients with IHF or dilated cardiomyopathy undergoing TLVR and reporting outcomes including LVEF, LV end‐diastolic volume (LVEDV), New York Heart Association (NYHA) class, or Kansas City Cardiomyopathy Questionnaire (KCCQ). Single‐arm interventional and observational cohort studies were included. Data extraction was performed by four reviewers, with bias assessed using ROBINS‐I and the Newcastle–Ottawa Scale. Pooled mean differences (MD) were calculated using a random‐effects model (Hartung–Knapp–Sidik–Jonkman). Seventeen studies were included, with baseline LVEF 22.8%–38% and LVEDV 75–235 mL. TLVR significantly reduced LVEDV (MD −25.94 mL; p < 0.00001), increased LVEF (+6.69%; p < 0.00001), and improved the NYHA class (MD −0.73; p = 0.02). KCCQ scores improved in some studies but were not significant overall. Revivent TC and AccuCinch showed consistent benefits, whereas Parachute outcomes were more variable. This meta‐analysis of TLVR demonstrates consistent improvements in LV remodeling, function, and symptoms. Nonetheless, high heterogeneity, small cohorts, and limited follow‐up highlight the need for large randomized trials to establish durability, survival benefit, and refine patient selection.