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12.02.2019 | Original Paper

Intravascular ultrasound guidance reduces cardiac death and coronary revascularization in patients undergoing drug-eluting stent implantation: results from a meta-analysis of 9 randomized trials and 4724 patients

Zeitschrift:
The International Journal of Cardiovascular Imaging
Autoren:
Xiao-Fei Gao, Zhi-Mei Wang, Feng Wang, Yue Gu, Zhen Ge, Xiang-Quan Kong, Guang-Feng Zuo, Jun-Jie Zhang, Shao-Liang Chen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10554-019-01555-3) contains supplementary material, which is available to authorized users.
Xiao-Fei Gao and Zhi-Mei Wang contributed equally to this work.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Intravascular ultrasound (IVUS) guidance is not routinely performed in real-word clinical practice partly because the benefit of IVUS guidance is not well established. This updated meta-analysis aims to compare IVUS-guided and angiography-guided drug-eluting stent (DES) implantation, simultaneously stressing the value of an optimal IVUS-defined procedure. Medline, Scopus, Google Scholar, and Cochrane Controlled Trials Registry were searched for the randomized trials comparing IVUS-guided and angiography-guided DES implantation. Nine eligible randomized trials including 4,724 patients were identified. At a mean follow-up of 16.7 months, IVUS guidance was associated with a significant lower risk of major adverse cardiovascular events (MACE) [5.4% vs. 9.0%; relative risks (RR): 0.61, 95% confident interval (CI) 0.49–0.74, p < 0.001], cardiac death (0.6% vs. 1.2%; RR: 0.49, 95% CI 0.26–0.92, p = 0.03), target vessel revascularization (3.5% vs .6.1%; RR: 0.58, 95% CI 0.42–0.80, p = 0.001), target lesion revascularization (3.1% vs. 5.2%; RR: 0.59, 95% CI 0.44–0.80, p = 0.001), and definite/probable stent thrombosis (0.5% vs .1.1%; RR: 0.45, 95% CI 0.23–0.87, p = 0.02) compared with angiography guidance. No significant differences in all cause death and myocardial infarction were noted between the two groups. Subgroup analysis showed that patients who met the optimal criteria had a lower rate of MACE than those with IVUS-defined suboptimal procedure (RR: 0.33, 95% CI 0.06–0.60, p = 0.02). The present meta-analysis with the largest sample size to date demonstrates that IVUS-guided DES implantation significantly reduces cardiac death, coronary revascularization and stent thrombosis, particularly for patients with IVUS-defined optimal procedures compared with angiography guidance.

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Zusatzmaterial
Supplementary material 1 Supplement Figure 1. Study flowchart. (TIF 691 KB)
10554_2019_1555_MOESM1_ESM.tif
Supplementary material 2 Supplement Figure 2. Funnel plot of publication bias for major adverse cardiovascular events (MACE) (A), cardiac death (B), all cause death (C), myocardial infarction (D), target vessel revascularization (TVR) (E), target lesion revascularization (TLR) (F), and stent thrombosis (G). (TIF 365 KB)
10554_2019_1555_MOESM2_ESM.tif
Supplementary material 3 Supplement Figure 3. Sensitivity analysis of MACE by omitting a single study from the overall analysis one at a time. (TIF 1671 KB)
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Supplementary material 4 (DOCX 154 KB)
10554_2019_1555_MOESM4_ESM.docx
Literatur
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