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Abstract

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Novel developments in revascularization for left main coronary artery disease Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study Outcomes After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting According to Lesion Site Results From the EXCEL Trial Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial Intravascular Ultrasound to Guide Left Main Stem Intervention: A Sub-Study of the NOBLE Trial Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial
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Review ArticleJuly 27, 2017

JOURNAL：Oncotarget. Article Link

Intravascular ultrasound guidance in drug-eluting stents implantation: a meta-analysis and trial sequential analysis of randomized controlled trials

Qian C, Feng H, Cao J et al. Keywords: intravascular ultrasound, drug-eluting stents, meta-analysis, trial sequential analysis, randomized controlled trials

META-ANALYSIS

OBJECTIVES - Previous evidence suggested that intravascular ultrasound (IVUS) guidance could improve outcomes after drug-eluting stents (DES) placement, largely driven by data from observational studies. We, therefore, performed a meta-analysis and trial sequential analysis of randomized controlled trials to overcome this limitation.


RESULTS -  The retrieval process yielded 7 RCTs with 3,192 patients. Compared to the angiography guidance, IVUS-guided DES implantation was associated with a significant reduction in the major adverse cardiac events (MACE) (OR 0.60, 95% CI 0.46-0.78; P < 0.001), target vessel revascularization (OR 0.60, 95% CI 0.40-0.91; P = 0.02) and target lesion revascularization (OR 0.60, 95% CI 0.42-0.85; P = 0.004). IVUS and conventional angiography guidance showed similar incidence of stent thrombosis (ST) (OR 0.56, 95% CI 0.25-1.23; P = 0.15), cardiac death (OR 0.47, 95% CI 0.19-1.15; P = 0.10) and myocardial infarction (OR 0.85, 95% CI 0.45-1.61; P = 0.62). Trial sequential analysis revealed a definite reduction in MACE with IVUS guidance without solid evidence for ST.


MATERIALS AND METHODS - A systematical literature search was performed in the databases of PubMed, the Cochrane Library and ClinicalTrials.gov, complemented with reference screening from relevant articles. Primary endpoints were MACE and ST.


CONCLUSIONS - IVUS-guided DES implantation is associated with a lower risk of MACE and revascularization without conclusive benefits for ST.

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