Abstract 14107: Impact of Intravascular Ultrasound Guidance on Clinical Outcomes Following Drug-Eluting Stent Implantation: A Meta-Analysis
Background: Although intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduced restenosis and clinical outcomes in bare-metal stent (BMS) era, it is still controversial whether PCI with drug-eluting stents (DES) guided by IVUS leads to better clinical outcomes.
Methods: We searched MEDLINE, EMBASE, and Cochrane databases for studies comparing IVUS-guided and conventional angiography-guided PCI with DES. Primary end point was major adverse cardiac events (MACEs; ie, death, myocardial infarction, or target vessel revascularization) at the longest follow-up. Incidence and adjusted summary estimates were pooled with generic-inverse variance random-effect or fixed effect methods (95% confidence intervals [CIs]).
Results: From 384 initial citations, 10 observational cohort studies and 1 randomized controlled trial with 10,916 patients (5,980 IVUS-guided and 4,936 angiography-guided) were included in this study. Mean follow-up duration for each study ranged from 12 to 48 months. Comparison of IVUS-guided versus angiography-guided PCI disclosed adjusted odds ratios (ORs) for MACE of 0.68 (95% CI 0.49 to 0.94, p=0.02) (Figure). IVUS-guided PCI was also associated with a significantly lower rate of long-term mortality (adjusted OR 0.64, 95% CI 0.49 to 0.83, p=0.001) and myocardial infarction (adjusted OR 0.55, 95% CI 0.35 to 0.88, p=0.01). However, no significant effect was seen for target vessel revascularization (adjusted OR 0.88, 95% CI 0.75 to 1.03, p=0.11).
Conclusions: IVUS-guided PCI with DES implantation was associated with significantly lower rates of mortality, MI, and MACE, with a neutral effect on TVR during a follow-up period of 12 to 48 months.
- © 2012 by American Heart Association, Inc.