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

BMC Cardiovascular Disorders

Research Article

Bill D. Gogas¹  Bo Xu²  Hao Zhu³  Xiao-Min Ren³  Shun-Yi Shi³  Dao-Rong Pan³  Wen Wu³  Yao-Jun Zhang³  Si Pang⁴  Xiao-Yun Chen⁴  Shao-Liang Chen⁵  Sheng-Jie Dong⁶  Christos V. Bourantas⁷  Javaid Iqbal⁸ 

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

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

DOI  :  10.1186/s12872-015-0144-8

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

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Zhang et al. 2015