- 作者：Jae-Sik Jang ; MD ; PhD&lowast ; ; jsjang@medimail.co.kr" class="auth_mail ; Yeo-Jeong Song ; MD&lowast ; ; Wook Kang ; MD&lowast ; ; Han-Young Jin ; MD&lowast ; ; Jeong-Sook Seo ; MD ; PhD&lowast ; ; Tae-Hyun Yang ; MD ; PhD&lowast ; ; Dae-Kyeong Kim ; MD ; PhD&lowast ; ; Kyoung-Im Cho ; MD ; PhD&dagger ; ; Bo-Hyun Kim ; MD ; PhD&Dagger ; ; Yong Hyun Park ; MD ; PhD§ ; ; Hyung-Gon Je ; MD ; PhD§ ; ; Dong-Soo Kim ; MD ; PhD&lowast ;
- 关键词：drug-eluting stent(s) ; intravascular ultrasound ; percutaneous coronary intervention
- 刊名：JACC: Cardiovascular Interventions
- 出版年：March, 2014
- 年：2014
- 卷：7
- 期：3
- 页码：233-243
- 全文大小：2154 K
Objectives
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聽= 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聽< 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聽= 0.01), and stent thrombosis (OR: 0.59; 95% CI: 0.42 to 0.82; p聽= 0.002). A聽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.