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

BMC Cardiovascular Disorders

Shao-Liang Chen⁶  Bo Xu⁸  Bill D. Gogas³  Javaid Iqbal⁴  Shun-Yi Shi²  Hao Zhu²  Xiao-Min Ren²  Wen Wu²  Sheng-Jie Dong⁵  Dao-Rong Pan²  Christos V. Bourantas⁷  Xiao-Yun Chen¹  Si Pang¹  Yao-Jun Zhang² 

[1] Medical School of Southeast University, Nanjing, China;Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China;Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA;University of Sheffield, Sheffield, UK;Department of the Joint and Bone Surgery, Yantaishan hospital, Yantai, Shandong province, China;Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing, 210006, Jiangsu, China;University College of London Hospital NHS Foundation Trust, University College of London, London, UK;Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China

关键词: Meta-analysis;    Drug-eluting stent;    Angiography;    Intravascular ultrasound;   

Others  :  1233952
DOI  :  10.1186/s12872-015-0144-8

 received in 2015-05-11, accepted in 2015-11-06,  发布年份 2015

【 摘 要 】

Background

Intravascular 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.

Methods

We 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.

Results

Twenty 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).

Conclusions

IVUS 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.

【 授权许可】

   
2015 Zhang et al.

【 图 表 】

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