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A Randomized Study of Distal Filter Protection Versus Conventional Treatment During Percutaneous Coronary Intervention in Patients With Attenuated Plaque Identified by Intravascular Ultrasound Phenomapping for Novel Classification of Heart Failure With Preserved Ejection Fraction The pyruvate-lactate axis modulates cardiac hypertrophy and heart failure Temporal Trends in Inpatient Use of Intravascular Imaging Among Patients Undergoing Percutaneous Coronary Intervention in the United States Therapeutic Options for In-Stent Restenosis Derivation, Validation, and Prognostic Utility of a Prediction Rule for Nonresponse to Clopidogrel: The ABCD-GENE Score Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial Surgery Does Not Improve Survival in Patients With Isolated Severe Tricuspid Regurgitation Mechanical circulatory support devices in advanced heart failure: 2020 and beyond Cardiovascular biomarkers in patients with acute decompensated heart failure randomized to sacubitril-valsartan or enalapril in the PIONEER-HF trial
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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.

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