Meta-Analysis of Outcomes After Intravascular Ultrasound–Guided Versus Angiography-Guided Drug-Eluting Stent Implantation in 26,503 Patients Enrolled in Three Randomized Trials and 14 Observational Studies

Ahn, Jung‐Min; Kang, Soo–Jin; Yoon, Sung‐Han; Park, Hyun Woo; Kang, Seung Mo; Lee, Jong‐Young; Lee, Seung-Whan; Kim, Young‐Hak; Lee, Cheol Whan; Park, Seong-Wook; Mintz, Gary S.

doi:10.1016/j.amjcard.2013.12.043

Cited by 208 publications

(129 citation statements)

References 27 publications

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“…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).…”

Section: Data Sourcesmentioning

confidence: 99%

“…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.…”

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Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Elgendy

Mahmoud

Bavry

2016

Circ: Cardiovascular Interventions

172

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I ntravascular ultrasound (IVUS) is a useful tool for optimization of stent implantation by insuring good stent expansion and apposition. [1][2][3][4][5] Despite this benefit, routine IVUS is limited by cost considerations and additional time that is needed to perform the procedure. It is also unknown which coronary lesion characteristics are best served by IVUS. A meta-analysis of randomized trials in the era of bare-metal stents concluded that IVUS guidance was associated with a reduction in major adverse cardiac events (MACE) and repeat revascularization with a neutral effect on death and myocardial infarction (MI).6 Percutaneous coronary intervention (PCI) is currently performed with drug-eluting stents, which has significantly reduced the risk for restenosis, compared with bare-metal stents.7 A large-scale network meta-analysis demonstrated that all drug-eluting stents (and in particular second generation drug-eluting stents) reduce adverse events compared with bare-metal stents.8 Accordingly, in present day practice, there may be less need for a routine IVUS-guided PCI approach. 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. Methods and Results-Randomized trials that reported clinical outcomes and compared routine IVUS-guided stent implantation with an angiography-guided approach in the era of drug-eluting stents were included. Summary estimates were constructed primarily using the Peto model. Seven trials with 3192 patients were analyzed. The mean length of the coronary lesions was 32 mm. At a mean of 15 months, routine IVUS-guided percutaneous coronary intervention was associated with a reduction in the risk of major adverse cardiac events (6.5% versus 10.3%; odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly because of reduction in the risk of ischemia-driven target lesion revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5% versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00; P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95% confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the IVUS-guided group. Conclusions-In the era of drug-eluting stents for diffuse coronary lesions, IVUS-guided percutaneous coronary intervention is superior to angiography-guided percutaneous coronary intervention...

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Section: Data Sourcesmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Elgendy

Mahmoud

Bavry

2016

Circ: Cardiovascular Interventions

172

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“…Nevertheless, the effectiveness of DES technology came at the cost of a greater risk of late and very late stent thrombosis (ST) (4). To overcome this limitation, refinements in stent geometry with thinner struts, more biocompatible polymers, lower drug dose eluted, PCI techniques (i.e., intravascular imaging guided procedures) in conjunction with potent adjunct pharmacological therapy (i.e., dual antiplatelet therapy) have further enhanced late DES safety profile (4)(5)(6). However, despite the reduction in thrombotic events with newergeneration DES to rates lower than 1%, ST still remains a catastrophic complication of PCI with high mortality rate (7,8).…”

Section: Introductionmentioning

confidence: 99%

Coronary stent thrombosis: what have we learned?

et al. 2016

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“…Intravascular ultrasound (IVUS), a catheter based imaging technique providing high resolution cross-sectional images of the lumen and vessel wall, has been used for more than two decades to guide PCI in different subsets of coronary artery lesions in diseased patent coronary arteries [1][2][3]. Recently, the interest in IVUS use during percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has dramatically increased [4][5][6].…”

Section: Introductionmentioning

confidence: 99%