title: Impact of intravascular ultrasound-guided stenting on long-term clinical outcome: a meta-analysis of available studies comparing intravascular ultrasound-guided and angiographically guided stenting.
abstract: To date, only a few studies have compared the clinical efficacy of intracoronary ultrasound (IVUS)-guided to angiographically guided stenting. Furthermore, it is not yet known whether the lower restenosis rate shown with the former strategy would translate into a substantial clinical advantage. Therefore, the aim of the present investigation was to improve the level of evidence of these studies by means of a formal meta-analysis. Nine studies were considered suitable for analysis. Odds ratios (ORs) were calculated for 6-month clinical follow-up. Primary endpoint was a composite of death and nonfatal myocardial infarction (MI), as considered in every single study. Secondary endpoints were major adverse cardiac events (MACEs), according to single study definition, the individual cardiac events, as well as several pre- and postprocedure and follow-up angiographic parameters. Overall, 2,972 patients were included. At 6 months, the OR for death and nonfatal MI was 1.13 (95% CI = 0.79-1.61; P = 0.5) for patients with IVUS-guided stenting. However, patients with IVUS-guided stenting had less target vessel revascularizations (OR = 0.62; 95% CI = 0.49-0.78; P = 0.00003) and MACEs (OR = 0.79; 95% CI = 0.64-0.98; P = 0.03) compared to angiographically guided stenting. In addition, subjects treated with IVUS-guided stenting had significantly less binary restenosis (OR = 0.75; 95% CI = 0.60-0.94; P = 0.01). The present meta-analysis demonstrates that IVUS-guided stenting implantation has a neutral effect on long-term death and nonfatal MI compared to an angiographic optimization. However, IVUS-guided stenting significantly lowers 6-month angiographic restenosis and target vessel revascularizations. Whether these benefits could be very helpful when dealing with lesions at high risk for restenosis is still an issue.
authors.affiliation: Catheterization Laboratory, Ospedale Maggiore, Bologna, Italy. gcas@fastmail.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
authors.forename: Filippo
authors.initials: F
authors.lastname: Ottani
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Pietro
authors.initials: P
authors.lastname: Sangiorgio
authors.forename: Daniele
authors.initials: D
authors.lastname: Bracchetti
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011336:Probability; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*