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Intravascular ultrasound-guided stent implantation reduces cardiovascular mortality - Updated meta-analysis of randomized controlled trials
- Source :
- International journal of cardiology. 299
- Publication Year :
- 2019
-
Abstract
- The use of intravascular ultrasound (IVUS) guidance to facilitate stent implantation has been demonstrated to reduce major adverse cardiovascular events (MACE), predominantly due to a reduction in target lesion revascularization (TLR). The objectives of our meta-analysis are to assess the effect of IVUS on clinical outcomes, including cardiovascular mortality.RCTs comparing drug-eluting stent (DES) implantation using IVUS plus angiography versus angiography alone were identified from a comprehensive search in PubMed, Embase, and Cochrane library. Pooled relative risks (RR) were obtained using DerSimonian and Laird estimator for the random effects model.The search yielded 10 RCTs (5007 participants) in which the relevant data were available. Two trials were performed in patients with chronic total occlusion (CTO), whereas other trials included patients that either had stable ischemic heart disease (22-64%) or presented as an acute coronary syndrome (ACS) (36-78%). Routine use of IVUS was effective in reducing TLR (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.44, 0.80; p 0.01), target vessel revascularization (TVR) (RR 0.59, 95% CI 0.43, 0.81; p 0.01), and MACE (RR 0.63, 95% CI 0.51, 0.77; p 0.01). Cardiovascular mortality was also significantly reduced (RR 0.51, 95% CI 0.27, 0.96; p = 0.04).During DES implantation, the routine use of IVUS in addition to angiography improves clinical outcomes, including cardiovascular mortality. These findings reinforce the need for a broader implementation of IVUS-guidance during PCI. Since a significant proportion of patients studied presented as ACS, future trials should assess the benefit of IVUS-guidance in a more focused presentation setting.
- Subjects :
- medicine.medical_specialty
Acute coronary syndrome
medicine.medical_treatment
030204 cardiovascular system & hematology
Cochrane Library
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
Intravascular ultrasound
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Mortality
Ultrasonography, Interventional
Randomized Controlled Trials as Topic
medicine.diagnostic_test
business.industry
Stent
Drug-Eluting Stents
medicine.disease
surgical procedures, operative
Cardiovascular Diseases
Conventional PCI
Angiography
Cardiology
Cardiology and Cardiovascular Medicine
business
Mace
Subjects
Details
- ISSN :
- 18741754
- Volume :
- 299
- Database :
- OpenAIRE
- Journal :
- International journal of cardiology
- Accession number :
- edsair.doi.dedup.....7cea08b1d7a01fc1ff9689dcebc28057