Author + information
- Received June 21, 2016
- Revision received July 11, 2016
- Accepted July 14, 2016
- Published online November 14, 2016.
- Dong-Ho Shin, MD, MPH, DrPHa,
- Sung-Jin Hong, MDb,
- Gary S. Mintz, MDc,
- Jung-Sun Kim, MDa,d,
- Byeong-Keuk Kim, MDa,d,
- Young-Guk Ko, MDa,d,
- Donghoon Choi, MDa,d,
- Yangsoo Jang, MDa,d,e and
- Myeong-Ki Hong, MDa,d,e,∗ ()
- aDepartment of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
- bDepartment of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, South Korea
- cCardiovascular Research Foundation, New York, New York
- dCardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- eSeverance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
- ↵∗Reprint requests and correspondence:
Dr. Myeong-Ki Hong, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu 03722, Seoul, South Korea.
Objectives The aim of this study was to evaluate the clinical usefulness of intravascular ultrasound (IVUS)–guided new-generation drug-eluting stent (DES) implantation using a meta-analysis of individual patient–level data from randomized trials.
Background Published randomized trials that compare IVUS-guided versus angiography-guided new-generation DES implantation are scarce.
Methods Searches of the MEDLINE, Embase, and Cochrane databases were performed to find randomized trials that compared IVUS-guided versus angiography-guided new-generation DES implantation. A total of 2,345 patients from 3 randomized trials were identified, and all patients were treated for long lesions or chronic total occlusions. Individual patient–level data were obtained. The primary endpoint was a major adverse cardiac event, a composite of cardiac death, myocardial infarction, or stent thrombosis. An intention-to-treat analysis and per protocol analysis were performed.
Results By 1 year post-procedure, major adverse cardiac events had occurred in 0.4% of the patients who underwent IVUS-guided DES implantation versus 1.2% of those who underwent angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided group, favorable clinical outcomes were observed for myocardial infarction (0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI: 0.12 to 0.89; p = 0.021).
Conclusions Compared with angiographic guidance, IVUS-guided new-generation DES implantation was associated with favorable outcomes in terms of major adverse cardiac events, the composite of cardiac death, myocardial infarction, or stent thrombosis. These findings must be interpreted only for complex lesions, because all identified patients had long lesions or chronic total occlusions.
This study was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare, South Korea (Nos. A085136 and HI15C1277), the Mid-Career Researcher Program through an NRF grant funded by the MEST, South Korea (No. 2015R1A2A2A01002731), and the Cardiovascular Research Center (Seoul, South Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 21, 2016.
- Revision received July 11, 2016.
- Accepted July 14, 2016.
- American College of Cardiology Foundation