Format

Send to

Choose Destination
Am Heart J. 2017 Mar;185:26-34. doi: 10.1016/j.ahj.2016.10.008. Epub 2016 Nov 12.

Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: Meta-analysis of randomized trials.

Author information

1
Mount Sinai St Luke's & Mount Sinai West Hospitals, New York, NY.
2
University of Utah, Salt Lake City, UT.
3
University of Louisville, Louisville, KY.
4
University of Alabama at Birmingham, Birmingham, AL.
5
Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
6
Columbia University Medical Center, New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY. Electronic address: gs2184@columbia.edu.

Abstract

The relative outcomes of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI with drug-eluting stent (DES) in complex lesions have not been established. We sought to compare the efficacy and safety of IVUS-guided PCI with angiography-guided PCI in patients with complex coronary lesions treated with DES.

METHODS:

Electronic databases were searched to identify all randomized trials comparing IVUS-guided vs angiography-guided DES implantation. We evaluated major adverse cardiac events (MACE), all-cause and cardiovascular death, myocardial infarction, target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis outcomes at the longest reported follow-up. Random-effects modeling was used to calculate pooled relative risk (RR) and 95% CIs.

RESULTS:

Eight trials comprising 3,276 patients (1,635 IVUS-guided and 1,641 angiography-guided) enrolling only patients with complex lesions were included. Mean follow-up was 1.4±0.5years. Compared with angiography-guided PCI, patients undergoing IVUS-guided PCI had significantly lower MACE (RR 0.64, 95% CI 0.51-0.80, P=.0001), TLR (RR 0.62, 95% CI 0.45-0.86, P=.004), and TVR (RR 0.60, 95% CI 0.42-0.87, P=.007). There were no significant differences for stent thrombosis, cardiovascular death, or all-cause death. In meta-regression analysis, IVUS-guided PCI was of greatest benefit in reducing MACE in patients with acute coronary syndromes, diabetes, and long lesions.

CONCLUSIONS:

The present meta-analysis demonstrates a significant reduction in MACE, TVR, and TLR with IVUS-guided DES implantation in complex coronary lesions.

PMID:
28267472
DOI:
10.1016/j.ahj.2016.10.008
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center