title: Outcomes With Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents.
abstract: BACKGROUND
  In the era of drug-eluting stents, it is unknown if intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention should be routinely endorsed. This study aimed to determine if IVUS-guided stent implantation is associated with improved outcomes.
  
  
  RESULTS
  Randomized trials that reported clinical outcomes and compared routine IVUS-guided stent implantation with an angiography-guided approach in the era of drug-eluting stents were included. Summary estimates were constructed primarily using the Peto model. Seven trials with 3192 patients were analyzed. The mean length of the coronary lesions was 32 mm. At a mean of 15 months, routine IVUS-guided percutaneous coronary intervention was associated with a reduction in the risk of major adverse cardiac events (6.5% versus 10.3%; odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly because of reduction in the risk of ischemia-driven target lesion revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5% versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00; P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95% confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the IVUS-guided group.
  
  
  CONCLUSIONS
  In the era of drug-eluting stents for diffuse coronary lesions, IVUS-guided percutaneous coronary intervention is superior to angiography-guided percutaneous coronary intervention in reducing the risk of major adverse cardiac events. This is primarily because of reduction in the risk of ischemia-driven target lesion revascularization. This analysis also suggests that risk of cardiovascular mortality and stent thrombosis might be lower with an IVUS-guided approach.
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., A.N.M., A.Y.E., A.A.B.); and North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., A.N.M., A.Y.E., A.A.B.); and North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Mahmoud
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., A.N.M., A.Y.E., A.A.B.); and North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
authors.forename: Akram Y
authors.initials: AY
authors.lastname: Elgendy
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., A.N.M., A.Y.E., A.A.B.); and North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.) anthony.bavry@va.gov.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / 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*; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: coronary artery disease; drug-eluting stents; meta-analysis; percutaneous coronary intervention; ultrasonography, interventional