Meta-Analysis of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation for Left Main Coronary Disease

Abstract

Percutaneous coronary intervention with drug-eluting stents (DES) has emerged as a reasonable alternative to bypass surgery for select patients with unprotected left main coronary artery (LMCA) disease. 1 Stone GW Kappetein AP Sabik JF Pocock SJ Morice MC Puskas J Kandzari DE Karmpaliotis D Brown 3rd, WM Lembo NJ Banning A Merkely B Horkay F Boonstra PW van Boven AJ Ungi I Bogáts G Mansour S Noiseux N Sabaté M Pomar J Hickey M Gershlick A Buszman PE Bochenek A Schampaert E Pagé P Modolo R Gregson J Simonton CA Mehran R Kosmidou I Généreux P Crowley A Dressler O Serruys PW Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med. 2019; 381: 1820-1830 Crossref PubMed Scopus (325) Google Scholar ,2 Elgendy IY Mahmoud AN Gad M Elgendy AY Bhatt DL Long-term outcomes with drug-eluting stents or coronary artery bypass surgery for unprotected left main coronary disease: a meta-analysis and trial sequential analysis of randomized trials. Am J Cardiol. 2020; https://doi.org/10.1016/j.amjcard.2020.04.005 Abstract Full Text Full Text PDF Scopus (2) Google Scholar Meta-analyses of randomized controlled trials (RCTs) documented a reduction in cardiovascular mortality and myocardial infarction with intravascular (IVUS) guidance for DES implantation 3 Malik AH Yandrapalli S Aronow WS Panza JA Cooper HA Intravascular ultrasound-guided stent implantation reduces cardiovascular mortality—updated meta-analysis of randomized controlled trials. Int J Cardiol. 2020; 299: 100-105 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ,4 Elgendy IY Mahmoud AN Elgendy AY Mintz GS Intravascular ultrasound-guidance is associated with lower cardiovascular mortality and myocardial infarction for drug-eluting stent implantation—insights from an updated meta-analysis of randomized trials. Circ J. 2019; 83: 1410-1413 Crossref PubMed Scopus (19) Google Scholar ; however, LMCA lesions were excluded from most of these trials. In the most recently published meta-analysis of 4,971 patients with LMCA disease, we found that IVUS-guided DES implantation to treat LMCA disease was associated with improved outcomes. 5 Elgendy IY Gad M Jain A Mahmoud AN Mintz GS Outcomes with intravascular ultrasound-guided drug eluting stent implantation for unprotected left main coronary lesions: a meta-analysis. Am J Cardiol. 2019; 124: 1652-1653 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Since that meta-analysis, further evidence with a larger number of patients has become available 6 Kinnaird T Johnson T Anderson R Gallagher S Sirker A Ludman P de Belder M Copt S Oldroyd K Banning A Mamas M Curzen N Intravascular imaging and 12-month mortality after unprotected left main stem PCI: an analysis from the British Cardiovascular Intervention Society Database. JACC Cardiovasc Interv. 2020; 13: 346-357 Crossref PubMed Scopus (31) Google Scholar ,7 Ladwiniec A Walsh SJ Holm NR Hanratty CG Mäkikallio T Kellerth T Hildick-Smith D Mogensen LJH Hartikainen J Menown IBA Erglis A Eriksen E Spence MS Thuesen L Christiansen EH Intravascular ultrasound to guide left main stem intervention: a sub-study of the NOBLE trial. EuroIntervention. 2020; ([Epub ahead of print])https://doi.org/10.4244/EIJ-D-19-01003 Crossref PubMed Scopus (4) Google Scholar ; thus, we performed an updated meta-analysis to evaluate the impact of IVUS-guided DES implantation for LMCA on individual outcomes measures.