Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis

Abstract

BackgroundIntravascular ultrasound (IVUS) can be a useful tool during drug-eluting stents (DES) implantation as it allows accurate assessment of lesion severity and optimal treatment planning. However, numerous reports have shown that IVUS guided percutaneous coronary intervention is not associated with improved clinical outcomes, especially in non-complex patients and lesions.MethodsWe searched the literature in Medline, the Cochrane Library, and other internet sources to identify studies that compare clinical outcomes between IVUS-guided and angiography-guided DES implantation. Random-effects model was used to assess treatment effect.ResultsTwenty eligible studies with a total of 29,068 patients were included in this meta-analysis. The use of IVUS was associated with significant reductions in major adverse cardiovascular events (MACE, odds ratios [OR] 0.77, 95 % confidence intervals [CI] 0.71-0.83, P < 0.001), death (OR 0.62, 95 % CI 0.54-0.71, p < 0.001), and stent thrombosis (OR 0.59, 95 % CI: 0.47-0.73, P < 0.001). The benefit was also seen in the repeated analysis of matched and randomized studies. In stratified analysis, IVUS guidance appeared to be beneficial not only in patients with complex lesions or acute coronary syndromes (ACS) but also patients with mixed lesions or presentations (MACE: OR 0.69, 95 % CI: 0.60-0.79, p < 0.001, OR 0.81, 95 % CI 0.74-0.90, p < 0.001, respectively). By employing meta-regression analysis, the benefit of IVUS is significantly pronounced in patients with complex lesions or ACS with respect to death (p = 0.048).ConclusionsIVUS guidance was associated with improved clinical outcomes, especially in patients with complex lesions admitted with ACS. Large, randomized clinical trials are warranted to identify populations and lesion characteristics where IVUS guidance would be associated with better outcomes.

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

“…Prior meta-analyses in the era of drug-eluting stents were limited by inclusion of observational studies. [9][10][11][12][13] The data analyzed from randomized trials in the earlier metaanalyses had failed to demonstrate the superiority of an IVUS-guided PCI approach because of limited number of randomized trials. By including the totality of data to date, this analysis showed the superiority of IVUS-guided PCI compared with angiography-guided PCI in the drugeluting stent era.…”

“…The reference lists of the retrieved articles and prior meta-analyses were reviewed. [9][10][11][12][13] This meta-analysis was registered at the PROSPERO international prospective register of systematic reviews (CRD42015029621).…”

“…Meta-analyses in the era of drug-eluting stents were influenced by including observational studies. [9][10][11][12][13] Furthermore, the results of additional multicenter randomized trials have become available.14-16 Therefore, we aimed to conduct an updated comprehensive meta-analysis of randomized trials to evaluate clinical outcomes associated with IVUSguided PCI compared with angiography-guided PCI in the era of drug-eluting stents.Background-In the era of drug-eluting stents, it is unknown if intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention should be routinely endorsed. This study aimed to determine if IVUS-guided stent implantation is associated with improved outcomes.…”

“…Meta-analyses in the era of drug-eluting stents were influenced by including observational studies. [9][10][11][12][13] Furthermore, the results of additional multicenter randomized trials have become available.…”

Comparação randomizada de intervenções coronárias percutâneas guiadas por tomografia de coerência óptica versus ultrassom intravascular versus angiografia: Estudo randomizado iSIGHT

“…De 2005 a 2017, foram publicados nove ensaios randomizados (o maior, IVUS-XPL, com 1.400 pacientes) (14,(75)(76)(77)(78)(79)(80)(81)(82) (12,(112)(113)(114)(115)(116)(117)(118) ; (b) quatro meta-análises que incluíram 3-8 ensaios randomizados (Tabela 3) (15)(16)(17)118) , e (c) duas meta-análises que avaliaram o papel da ICP guiada por USIC especificamente em pacientes tratados com SF de segunda geração (16,117) . nos casos com ICP guiada por angiografia (16) .…”