Author + information
- Received May 17, 2013
- Revision received September 11, 2013
- Accepted September 26, 2013
- Published online March 1, 2014.
- Jae-Sik Jang, MD, PhD∗∗ (, )
- Yeo-Jeong Song, MD∗,
- Wook Kang, MD∗,
- Han-Young Jin, MD∗,
- Jeong-Sook Seo, MD, PhD∗,
- Tae-Hyun Yang, MD, PhD∗,
- Dae-Kyeong Kim, MD, PhD∗,
- Kyoung-Im Cho, MD, PhD†,
- Bo-Hyun Kim, MD, PhD‡,
- Yong Hyun Park, MD, PhD§,
- Hyung-Gon Je, MD, PhD§ and
- Dong-Soo Kim, MD, PhD∗
- ∗Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea
- †Department of Cardiology, Kosin University Medical Center, Busan, South Korea
- ‡Department of Cardiology, Pusan National University Hospital, Busan, South Korea
- §Department of Cardiology and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
- ↵∗Reprint requests and correspondence:
Dr. Jae-Sik Jang, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South Korea.
Objectives The aim of this study was to systematically review and perform a meta-analysis of randomized trials and observational studies of intravascular ultrasound (IVUS)-guided versus angiography-guided implantation of drug-eluting stents (DES).
Background Although studies in the bare-metal stents era suggested that there were clinical benefits to IVUS guidance, it is still controversial whether percutaneous coronary intervention (PCI) with DES guided by IVUS leads to better clinical outcomes.
Methods Relevant studies published through March 31, 2013, were searched for and identified in the electronic databases. Summary estimates were obtained using a random-effects model.
Results From 138 initial citations, 3 randomized trials and 12 observational studies with 24,849 patients (11,793 IVUS-guided and 13,056 angiography-guided) were included in this study. Comparison of IVUS- versus angiography-guided PCI disclosed odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence interval [CI]: 0.69 to 0.91; p = 0.001). IVUS-guided PCI was also associated with significantly lower rates of all-cause mortality (OR: 0.64; 95% CI: 0.51 to 0.81; p < 0.001), myocardial infarction (OR: 0.57; 95% CI: 0.42 to 0.78; p < 0.001), target vessel revascularization (OR: 0.81; 95% CI: 0.68 to 0.95; p = 0.01), and stent thrombosis (OR: 0.59; 95% CI: 0.42 to 0.82; p = 0.002). A meta-analysis of propensity-matched studies demonstrated similar results in terms of clinical outcomes, but not repeat revascularization.
Conclusions IVUS-guided DES implantation is associated with significantly lower rates of adverse clinical events compared with angiography guidance. Further study is needed to clarify which subgroups of subjects with IVUS guidance will have greater benefit.
This work was supported by a 2013 Inje University research grant. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 17, 2013.
- Revision received September 11, 2013.
- Accepted September 26, 2013.
- American College of Cardiology Foundation