Author + information
- Dong-Ho Shin1,
- Sung-Jin Hong2,
- Gary Mintz3,
- Jung-Sun Kim4,
- Byeong-Keuk Kim5,
- Young-Guk Ko6,
- donghoon choi7,
- Yangsoo Jang8 and
- Myeong-Ki Hong9
- 1Interventional Cardiologist, Seoul, Korea, Republic of
- 2Sanggye paik hosptial, Seoul, Korea, Republic of
- 3Cardiovascular Research Foundation, Washington, District of Columbia, United States
- 4Unknown, Seoul, Korea, Republic of
- 5Yonsei Univ. Cardiovascular Hospital, Seoul, Korea, Republic of
- 6Unknown, Seoul, Korea, Republic of
- 7Severance Hospital, Seoul, Korea, Republic of
- 9Yonsei University College of Medicine, Seoul, Korea, Republic of
Randomized trials comparing intravascular ultrasound (IVUS)-guided vs. angiography-guided new-generation drug-eluting stent (DES) implantation were scarce. We evaluated the clinical usefulness of IVUS-guided new-generation DES implantation using meta-analysis with individual patient-level data from randomized trials.
Randomized trials comparing IVUS-guided vs. angiography-guided new-generation DES implantation were searched through MEDLINE, EMBASE and Cochrane databases. A total of 2,345 patients treated with new-geneation DES for complex coronary lesions from 3 randomized trials were identified and individual patient-level data was obtained. The primary end point was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, stent thrombosis or target-lesion revascularization. Secondary end point was the hard end point defined as a composite of cardiac death, myocardial infarction or stent thrombosis as well as individual components of the primary end point. All analyses were conducted by intention-to-treat.
At 1 year, the primary end point of MACE occurred in 4.5% of the patients receiving IVUS-guided DES implantation and in 7.4% of those receiving angiography-guided DES implantation (HR=0.54, 95% confidence interval [CI]=0.36–0.81, p=0.002). Favorable clinical outcomes for IVUS-guided group were observed for myocardial infarction (0% vs. 0.4%, HR=0.09, 95% CI=0.00-0.80, p=0.026) and target-lesion revascularization (5.0% vs. 6.8%, HR=0.61, 95% CI=0.40-0.93, p=0.021).
Compared to the angiography-guidance, IVUS-guided new-generation DES implantation was associated with favorable clinical outcomes which was driven by reduction of myocardial infarction and target-lesion revascularization.