Comparison of clinical outcomes between intravascular ultrasound-guided and angiography-guided drug-eluting stent implantation: A meta-analysis of randomised control trials and systematic review.

Abstract

This systematic review was designed to evaluate the overall efficacy of angiography-guided drug-eluting stent (DES) implantation vs intravascular ultrasound-guided (IVUS) implantation for percutaneous coronary intervention. The electronic databases CENTRAL, PubMed, Cochrane, and EMBASE were searched for systematic reviews to investigate angiography-guided and IVUS-guided DES implantation. We measured the following six parameters in each patient: cardiovascular death, stent thrombosis, target lesion revascularisation (TLR), myocardial infarction (MI), major adverse cardiac events (MACEs), and all-cause death. Twelve studies involving 6268 subjects were included, with 2984 receiving IVUS-guided DES implantation and 3284 using angiography-guided DES implantation. With regard to MACEs, TLR, MI, cardiovascular death, and all-cause death, the IVUS-guided DES implantation group had remarkably improved clinical outcomes. However, there was no significant statistical difference in stent thrombosis between the two groups. Dramatic decrease in MACEs through IVUS guidance was presented by trial sequential analysis. Remarkably improved clinical outcomes, including MACEs, cardiovascular death, all-cause death, and TLR, were identified through IVUS-guided DES implantation in comparison with angiography-guided DES implantation. Nonetheless, the effect on stent thrombosis and MI required further confirmation. In this meta-analysis, eligible randomised clinical trials were warranted to verify the findings and to determine the beneficial effect of IVUS guidance for patients.