title: Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: Meta-analysis of randomized trials.
abstract: The relative outcomes of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI with drug-eluting stent (DES) in complex lesions have not been established. We sought to compare the efficacy and safety of IVUS-guided PCI with angiography-guided PCI in patients with complex coronary lesions treated with DES.
  
  
  METHODS
  Electronic databases were searched to identify all randomized trials comparing IVUS-guided vs angiography-guided DES implantation. We evaluated major adverse cardiac events (MACE), all-cause and cardiovascular death, myocardial infarction, target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis outcomes at the longest reported follow-up. Random-effects modeling was used to calculate pooled relative risk (RR) and 95% CIs.
  
  
  RESULTS
  Eight trials comprising 3,276 patients (1,635 IVUS-guided and 1,641 angiography-guided) enrolling only patients with complex lesions were included. Mean follow-up was 1.4±0.5years. Compared with angiography-guided PCI, patients undergoing IVUS-guided PCI had significantly lower MACE (RR 0.64, 95% CI 0.51-0.80, P=.0001), TLR (RR 0.62, 95% CI 0.45-0.86, P=.004), and TVR (RR 0.60, 95% CI 0.42-0.87, P=.007). There were no significant differences for stent thrombosis, cardiovascular death, or all-cause death. In meta-regression analysis, IVUS-guided PCI was of greatest benefit in reducing MACE in patients with acute coronary syndromes, diabetes, and long lesions.
  
  
  CONCLUSIONS
  The present meta-analysis demonstrates a significant reduction in MACE, TVR, and TLR with IVUS-guided DES implantation in complex coronary lesions.
authors.affiliation: Mount Sinai St Luke's & Mount Sinai West Hospitals, New York, NY.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Mount Sinai St Luke's & Mount Sinai West Hospitals, New York, NY.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: University of Louisville, Louisville, KY.
authors.forename: Abdur Rahman
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Mount Sinai St Luke's & Mount Sinai West Hospitals, New York, NY.
authors.forename: Arpit
authors.initials: A
authors.lastname: Shah
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Sameer
authors.initials: S
authors.lastname: Ather
authors.affiliation: Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Mount Sinai St Luke's & Mount Sinai West Hospitals, New York, NY.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.affiliation: Columbia University Medical Center, New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY. Electronic address: gs2184@columbia.edu.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013927:Thrombosis / Q000453:epidemiology; D018084:Ultrasonography, Interventional