Intravascular Ultrasound Guidance for Drug-eluting Stent Implantation. A Comprehensive Meta-analysis of Clinical Trials
Wednesday, May 22, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Arshi Naz
,
Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan
Asra K Butt, M.D.
,
UTHSC, Memphis, TN
Pooja Sona Jagadish, M.D.
,
University of Tennessee Health Science Center, MEMPHIS, TN
Kirstin Hesterberg
,
University of Tennessee, Memphis, TN
James Turner
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Rahman Shah, M.D.
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Background:
Traditionally, coronary intervention has been performed using angiographic guidance. However, increasing evidence shows that outcomes can be improved by using intravascular ultrasound (IVUS) guidance, even for drug-eluting stent (DES) implantation. In recent months, results from the largest trial in this field (ULTIMATE) have been reported. Therefore, we performed an updated comprehensive meta-analysis of clinical trials to evaluate the impact of IVUS guidance for DES implantation on clinical outcomes.
Methods:
Scientific databases were searched for RCTs, and pooled risk ratios (RRs) were determined using a random effects model.
Results:
Data from 8 trials including 4640 patients were analyzed. Most of these trials included patients with complex lesions such as CTOs, long lesions, ACSs, bifurcations, or left main lesions. Compared to angiography guidance, IVUS-guided stent implantation significantly decreased MACE rates by 37%, for cardiac death by 49%, and for TLR by 43%. It was also associated with a numerically lower rate for MI (RR, 0.59; 95% CI, 0.33–1.04;
p = 0.070) and stent thrombosis (RR, 0.50; 95% CI, 0.24–1.04;
p = 0.064), but differences did not reach statistical significance.
Conclusions:
For DES implantation, IVUS guidance improves outcomes compared to angiographic guidance, particularly for complex lesions.
