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Intravascular Ultrasound-Guided Versus Angiography-Guided Implantation of Drug-Eluting Stent in All-Comers: The ULTIMATE trial Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study A volumetric intravascular ultrasound comparison of early drug-eluting stent thrombosis versus restenosis Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance Intravascular ultrasound guidance improves clinical outcomes during implantation of both first- and second-generation drug-eluting stents: a meta-analysis Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial Increased glycated albumin and decreased esRAGE levels in serum are related to negative coronary artery remodeling in patients with type 2 diabetes: an Intravascular ultrasound study Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis Comprehensive intravascular ultrasound assessment of stent area and its impact on restenosis and adverse cardiac events in 403 patients with unprotected left main disease
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Review Article2014 Mar;7(3):233-43.

JOURNAL：JACC Cardiovasc Interv. Article Link

Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis

Jang JS, Song YJ, Kang W et al. Keywords: drug-eluting stent(s); intravascular ultrasound; percutaneous coronary intervention

ABSTRACT

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.



Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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