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Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET Everolimus-Eluting Bioresorbable Scaffolds Versus Everolimus-Eluting Metallic Stents Anatomical plaque and vessel characteristics are associated with hemodynamic indices including fractional flow reserve and coronary flow reserve: A prospective exploratory intravascular ultrasound analysis Nonculprit Lesion Myocardial Infarction Following Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement Optical coherence tomography findings: insights from the “randomised multicentre trial investigating angiographic outcomes of hybrid sirolimus-eluting stents with biodegradable polymer compared with everolimus-eluting stents with durable polymer in chronic total occlusions” (PRISON IV) trial How Low to Go With Glucose, Cholesterol, and Blood Pressure in Primary Prevention of CVD

Review ArticleJuly 27, 2017

JOURNAL:Oncotarget. Article Link

Intravascular ultrasound guidance in drug-eluting stents implantation: a meta-analysis and trial sequential analysis of randomized controlled trials

Qian C, Feng H, Cao J et al. Keywords: intravascular ultrasound, drug-eluting stents, meta-analysis, trial sequential analysis, randomized controlled trials

ABSTRACT

OBJECTIVES - Previous evidence suggested that intravascular ultrasound (IVUS) guidance could improve outcomes after drug-eluting stents (DES) placement, largely driven by data from observational studies. We, therefore, performed a meta-analysis and trial sequential analysis of randomized controlled trials to overcome this limitation.


RESULTS -  The retrieval process yielded 7 RCTs with 3,192 patients. Compared to the angiography guidance, IVUS-guided DES implantation was associated with a significant reduction in the major adverse cardiac events (MACE) (OR 0.60, 95% CI 0.46-0.78; P < 0.001), target vessel revascularization (OR 0.60, 95% CI 0.40-0.91; P = 0.02) and target lesion revascularization (OR 0.60, 95% CI 0.42-0.85; P = 0.004). IVUS and conventional angiography guidance showed similar incidence of stent thrombosis (ST) (OR 0.56, 95% CI 0.25-1.23; P = 0.15), cardiac death (OR 0.47, 95% CI 0.19-1.15; P = 0.10) and myocardial infarction (OR 0.85, 95% CI 0.45-1.61; P = 0.62). Trial sequential analysis revealed a definite reduction in MACE with IVUS guidance without solid evidence for ST.


MATERIALS AND METHODS - A systematical literature search was performed in the databases of PubMed, the Cochrane Library and ClinicalTrials.gov, complemented with reference screening from relevant articles. Primary endpoints were MACE and ST.


CONCLUSIONS - IVUS-guided DES implantation is associated with a lower risk of MACE and revascularization without conclusive benefits for ST.