title: Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis.
abstract: OBJECTIVE
  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.
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea. Electronic address: jsjang@medimail.co.kr.
authors: Jae-Sik
authors: JS
authors: Jang
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Yeo-Jeong
authors: YJ
authors: Song
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Wook
authors: W
authors: Kang
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Han-Young
authors: HY
authors: Jin
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Jeong-Sook
authors: JS
authors: Seo
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Tae-Hyun
authors: TH
authors: Yang
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Dae-Kyeong
authors: DK
authors: Kim
authors: Department of Cardiology, Kosin University Medical Center, Busan, South Korea.
authors: Kyoung-Im
authors: KI
authors: Cho
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Bo-Hyun
authors: BH
authors: Kim
authors: Department of Cardiology and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors: Yong Hyun
authors: YH
authors: Park
authors: Department of Cardiology and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors: Hyung-Gon
authors: HG
authors: Je
authors: Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
authors: Dong-Soo
authors: DS
authors: Kim
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011474:Prosthesis Design; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: drug-eluting stent(s); intravascular ultrasound; percutaneous coronary intervention