Intravascular ultrasound guidance in drug-eluting stents implantation: a meta-analysis and trial sequential analysis of randomized controlled trials

// Cheng Qian 1 , Hong Feng 1 , Jianlei Cao 1 , Guangyu Zhang 1 and Yanggan Wang 1 1 Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China Correspondence to: Yanggan Wang, email: wb000813@whu.edu.cn Keywords: intravascular ultrasound, drug-eluting stents, meta-analysis, trial sequential analysis, randomized controlled trials Received: July 28, 2016 Accepted: July 11, 2017 Published: July 27, 2017 ABSTRACT Objective: Previous evidence suggested that intravascular ultrasound (IVUS) guidance could improve outcomes after drug-eluting stents (DES) placement, largely driven by data from observational studies. We, therefore, performed a meta-analysis and trial sequential analysis of randomized controlled trials to overcome this limitation. Results: The retrieval process yielded 7 RCTs with 3,192 patients. Compared to the angiography guidance, IVUS-guided DES implantation was associated with a significant reduction in the major adverse cardiac events (MACE) (OR 0.60, 95% CI 0.46-0.78; P < 0.001), target vessel revascularization (OR 0.60, 95% CI 0.40-0.91; P = 0.02) and target lesion revascularization (OR 0.60, 95% CI 0.42-0.85; P = 0.004). IVUS and conventional angiography guidance showed similar incidence of stent thrombosis (ST) (OR 0.56, 95% CI 0.25-1.23; P = 0.15), cardiac death (OR 0.47, 95% CI 0.19-1.15; P = 0.10) and myocardial infarction (OR 0.85, 95% CI 0.45-1.61; P = 0.62). Trial sequential analysis revealed a definite reduction in MACE with IVUS guidance without solid evidence for ST. Materials and Methods: A systematical literature search was performed in the databases of PubMed, the Cochrane Library and ClinicalTrials. gov , complemented with reference screening from relevant articles. Primary endpoints were MACE and ST. Conclusions: IVUS-guided DES implantation is associated with a lower risk of MACE and revascularization without conclusive benefits for ST.