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Intravascular Ultrasound-Guided Implantation of Drug-Eluting Stents to Improve Outcome: A Meta-Analysis

https://doi.org/10.1016/j.jcin.2013.09.013Get rights and content
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Objectives

The aim of this study was to systematically review and perform a meta-analysis of randomized trials and observational studies of intravascular ultrasound (IVUS)-guided versus angiography-guided implantation of drug-eluting stents (DES).

Background

Although studies in the bare-metal stents era suggested that there were clinical benefits to IVUS guidance, it is still controversial whether percutaneous coronary intervention (PCI) with DES guided by IVUS leads to better clinical outcomes.

Methods

Relevant studies published through March 31, 2013, were searched for and identified in the electronic databases. Summary estimates were obtained using a random-effects model.

Results

From 138 initial citations, 3 randomized trials and 12 observational studies with 24,849 patients (11,793 IVUS-guided and 13,056 angiography-guided) were included in this study. Comparison of IVUS- versus angiography-guided PCI disclosed odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence interval [CI]: 0.69 to 0.91; p = 0.001). IVUS-guided PCI was also associated with significantly lower rates of all-cause mortality (OR: 0.64; 95% CI: 0.51 to 0.81; p < 0.001), myocardial infarction (OR: 0.57; 95% CI: 0.42 to 0.78; p < 0.001), target vessel revascularization (OR: 0.81; 95% CI: 0.68 to 0.95; p = 0.01), and stent thrombosis (OR: 0.59; 95% CI: 0.42 to 0.82; p = 0.002). A meta-analysis of propensity-matched studies demonstrated similar results in terms of clinical outcomes, but not repeat revascularization.

Conclusions

IVUS-guided DES implantation is associated with significantly lower rates of adverse clinical events compared with angiography guidance. Further study is needed to clarify which subgroups of subjects with IVUS guidance will have greater benefit.

Key Words

drug-eluting stent(s)
intravascular ultrasound
percutaneous coronary intervention

Abbreviations and Acronyms

BMS
bare-metal stent(s)
CI
confidence interval
DES
drug-eluting stent(s)
HR
hazard ratio
IVUS
intravascular ultrasound
MACE
major adverse cardiac events
MI
myocardial infarction
OR
odds ratio
PCI
percutaneous coronary intervention
TLR
target lesion revascularization
TVR
target vessel revascularization

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This work was supported by a 2013 Inje University research grant. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.