title: Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Intravascular ultrasound (IVUS) can be a useful tool during drug-eluting stents (DES) implantation as it allows accurate assessment of lesion severity and optimal treatment planning. However, numerous reports have shown that IVUS guided percutaneous coronary intervention is not associated with improved clinical outcomes, especially in non-complex patients and lesions.
  
  
  METHODS
  We searched the literature in Medline, the Cochrane Library, and other internet sources to identify studies that compare clinical outcomes between IVUS-guided and angiography-guided DES implantation. Random-effects model was used to assess treatment effect.
  
  
  RESULTS
  Twenty eligible studies with a total of 29,068 patients were included in this meta-analysis. The use of IVUS was associated with significant reductions in major adverse cardiovascular events (MACE, odds ratios [OR] 0.77, 95 % confidence intervals [CI] 0.71-0.83, P < 0.001), death (OR 0.62, 95 % CI 0.54-0.71, p < 0.001), and stent thrombosis (OR 0.59, 95 % CI: 0.47-0.73, P < 0.001). The benefit was also seen in the repeated analysis of matched and randomized studies. In stratified analysis, IVUS guidance appeared to be beneficial not only in patients with complex lesions or acute coronary syndromes (ACS) but also patients with mixed lesions or presentations (MACE: OR 0.69, 95 % CI: 0.60-0.79, p < 0.001, OR 0.81, 95 % CI 0.74-0.90, p < 0.001, respectively). By employing meta-regression analysis, the benefit of IVUS is significantly pronounced in patients with complex lesions or ACS with respect to death (p = 0.048).
  
  
  CONCLUSIONS
  IVUS guidance was associated with improved clinical outcomes, especially in patients with complex lesions admitted with ACS. Large, randomized clinical trials are warranted to identify populations and lesion characteristics where IVUS guidance would be associated with better outcomes.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 13770668667@139.com.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 13951617825@139.com.|Medical School of Southeast University, Nanjing, China. 13951617825@139.com.
authors.forename: Si
authors.initials: S
authors.lastname: Pang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. siry_chen1226@126.com.|Medical School of Southeast University, Nanjing, China. siry_chen1226@126.com.
authors.forename: Xiao-Yun
authors.initials: XY
authors.lastname: Chen
authors.affiliation: University College of London Hospital NHS Foundation Trust, University College of London, London, UK. cbourantas@gmail.com.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. pdrcn2014@163.com.
authors.forename: Dao-Rong
authors.initials: DR
authors.lastname: Pan
authors.affiliation: Department of the Joint and Bone Surgery, Yantaishan hospital, Yantai, Shandong province, China. dongshengjay@126.com.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. timwu1988@126.com.
authors.forename: Wen
authors.initials: W
authors.lastname: Wu
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. renxm0073@163.com.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Ren
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 1013656830@qq.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Ssy10170819@126.com.
authors.forename: Shun-Yi
authors.initials: SY
authors.lastname: Shi
authors.affiliation: University of Sheffield, Sheffield, UK. j.iqbal@sheffield.ac.uk.
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA. bgogas@gmail.com.
authors.forename: Bill D
authors.initials: BD
authors.lastname: Gogas
authors.affiliation: Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China. bxu@citmd.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. chmengx126@gmail.com.|Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, 210006, Nanjing, Jiangsu, China. chmengx126@gmail.com.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011237:Predictive Value of Tests; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional