Meta-analysis and systematic review of intravascular ultrasound versus angiography-guided drug eluting stent implantation in left main coronary disease in 4592 patients

Yue Wang,Xiaofan Wu,Yue Qi,Mengru Liu,Zhichun Gu,Gary S Mintz

doi:10.1186/s12872-018-0843-z

Abstract

BackgroundAlthough several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset.MethodsWe performed a meta-analysis to compare clinical outcomes of IVUS versus conventional angiography guidance during implantation of DES for patients with LMCA disease. Pubmed, Cochrane Library, Embase were searched.ResultsA total of 1002 publications were reviewed; and finally, seven clinical studies - one prospective randomized controlled trial and six observational studies with 4592 patients (1907 IVUS-guided and 2685 angiography-guided) - were included in the meta-analysis. IVUS guidance was associated with a significant reduction in major adverse cardiac events (relative ratio [RR] 95% CI 0.61; 95% confidence interval [CI] 0.53 to 0.70; P < 0.001), all-cause death (RR 0.55; 95% CI 0.42 to 0.71; P < 0.001), cardiac death (RR 0.45; 95% CI 0.32 to 0.62; P < 0.001), myocardial infarction (RR 0.66; 95% CI 0.55 to 0.80; P < 0.001), and stent thrombosis (RR 0.48; 95% CI 0.27 to 0.84; P = 0.01) compared with angiographic guidance. However, there was no significant difference regarding target lesion revascularization (RR 0.60; 95% CI 0.31 to 1.18; P = 0.099) and target vessel revascularization (RR 0.64; 95% CI 0.26 to 1.56; P = 0. 322).ConclusionsCompared to angiographic guidance, IVUS-guided DES implantation was associated with better clinical outcomes for patients with LMCA lesions, especially hard endpoints of death, myocardial infarction, and stent thrombosis.

Highlights

Several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset
Mesh and combinations of the following terms were used in the search process: “ultrasonography, intravascular,” “intravascular ultrasound,” “intravascular ultrasoundguided,” “IVUS,” “IVUS-guided,” “angiography,” “angiography-guided,” “left main coronary artery,” “left main coronary stenosis,” “left main coronary disease,” “left main,” “left main lesion,” “LMCA,” “drug-eluting stent,” “sirolimus-eluting stent,” “paclitaxel-eluting stent,” “everolimus-eluting stent,” “zotarolimus-eluting stent,” “stent,” and “DES.” Two investigators (Yue Wang* and Yue Qi) independently screened the titles and abstracts and eventually examined the full texts of the original reports included in the study
Studies with incomplete information - including abstracts of major meetings (Transcatheter Cardiovascular Therapeutics [TCT], Angioplasty Summit, American Heart Association [AHA], American College of Cardiology [ACC], EuroPCR, and World Congress of Cardiology [WCC]) and studies of IVUS versus angiography-guided DES implantation that included a subgroup of LMCA patients - were reviewed for other potentially relevant citations

Summary

Introduction

Several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset. Intravascular ultrasound (IVUS) has played a key role in contemporary stent-based percutaneous coronary interventions (PCI) by providing more detailed coronary anatomic information, assessing plaque burden accurately, selecting proper stent sizes, and optimizing stent expansion, apposition, and geographic miss [1,2,3,4,5]. One meta-analysis of seven randomized trials in the bare metal stent era [6]. Wang et al BMC Cardiovascular Disorders (2018) 18:115 current meta-analysis of published studies comparing IVUS-guided versus angiography-guided DES implantation to treat LMCA lesions

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Results

Discussion

Conclusion