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Title: | Intravascular ultrasound guidance improves clinical outcomes during implantation of both first-and secondgeneration drug-eluting stents: A meta-analysis. | Authors: | Brown A.J.;Ihdayhid A.-R.;McCormick L.M.;Cameron J.D.;Bennett M.R.;Malaiapan Y.;Meredith I.T. ;Nerlekar N. ;Cheshire C.J.;Verma K.P. | Institution: | (Nerlekar, Cheshire, Verma, Ihdayhid, McCormick, Cameron, Malaiapan, Meredith, Brown) Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Clayton, VIC 3168, Australia (Bennett, Brown) Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom | Issue Date: | 10-Apr-2017 | Copyright year: | 2017 | Publisher: | EuroPCR | Place of publication: | France | Publication information: | EuroIntervention. 12 (13) (pp 1632-1642), 2017. Date of Publication: 2017. | Journal: | EuroIntervention | Abstract: | Aims: Our aim was to assess whether intravascular ultrasound (IVUS) improves clinical outcomes during implantation of first-and second-generation drug-eluting stents (DES). IVUS guidance is associated with improved clinical outcomes during DES implantation, but it is unknown whether this benefit is limited to either first-or second-generation devices. Methods and Results: MEDLINE, EMBASE and PubMed were searched for studies comparing outcomes between IVUS-and angiography-guided PCI. Among 909 potentially relevant studies, 15 trials met the inclusion criteria. The primary endpoint was MACE, defined as death, myocardial infarction, target vessel/ lesion revascularisation (TVR/TLR) or stent thrombosis (ST). Summary estimates were obtained using Peto modelling. In total, 9,313 patients from six randomised trials and nine observational studies were included. First-generation DES were implanted in 6,156 patients (3,064 IVUS-guided and 3,092 angiography-guided) and second-generation in 3,157 patients (1,528 IVUS-guided and 1,629 angiography-guided). IVUS guidance was associated with a significant reduction in MACE (odds ratio [OR] 0.73, 95% CI: 0.64-0.85, p<0.001), across both first-(OR 0.79, 95% CI: 0.67-0.92, p=0.01) and second-generation DES (0.57, 95% CI: 0.43-0.77, p<0.001). For second-generation DES, IVUS guidance was associated with significantly lower rates of cardiac death (OR 0.33, 95% CI: 0.14-0.78, p=0.02), TVR (OR 0.47, 95% CI: 0.28-0.79, p=0.006), TLR (OR 0.61, 95% CI: 0.42-0.90, p=0.01) and ST (OR 0.31, 95% CI: 0.12-0.78, p=0.02). Cumulative meta-analysis highlighted progressive temporal benefit towards IVUS-guided PCI to reduce MACE (OR 0.60, 95% CI: 0.48-0.75, p<0.001). Conclusion(s): IVUS guidance is associated with a significant reduction in MACE during implantation of both first-and second-generation DES platforms. These data support the use of IVUS guidance in contemporary revascularisation procedures using second-generation DES.Copyright © Europa Digital & Publishing 2017. All rights reserved. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.4244/EIJ-D-16-00769 | Link to associated publication: | Click here for full text options | PubMed URL: | 27840327 [http://www.ncbi.nlm.nih.gov/pubmed/?term=27840327] | ISSN: | 1774-024X | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/39475 | Type: | Article | Subjects: | paclitaxel eluting coronary stent percutaneous coronary intervention randomized controlled trial (topic) sirolimus eluting coronary stent stent thrombosis/co [Complication] *intravascular ultrasound systematic review medical device complication/co [Complication] meta analysis observational study coronary angiography coronary artery disease/dt [Drug Therapy] *coronary stenting *drug eluting coronary stent everolimus eluting coronary stent heart death/co [Complication] heart infarction/co [Complication] heart muscle revascularization human zotarolimus eluting coronary stent everolimus/dt [Drug Therapy] paclitaxel/dt [Drug Therapy] rapamycin/dt [Drug Therapy] zotarolimus/dt [Drug Therapy] *drug eluting coronary stent/am [Adverse Device Effect] everolimus eluting coronary stent/am [Adverse Device Effect] paclitaxel eluting coronary stent/am [Adverse Device Effect] sirolimus eluting coronary stent/am [Adverse Device Effect] zotarolimus eluting coronary stent/am [Adverse Device Effect] article cardiovascular disease/co [Complication] *clinical outcome systematic review Article cardiovascular disease / complication *clinical outcome coronary angiography coronary artery disease / drug therapy *coronary stenting *drug eluting coronary stent everolimus eluting coronary stent heart death / complication heart infarction / complication heart muscle revascularization human *intravascular ultrasound medical device complication / complication meta analysis observational study paclitaxel eluting coronary stent percutaneous coronary intervention randomized controlled trial (topic) sirolimus eluting coronary stent stent thrombosis / complication zotarolimus eluting coronary stent |
Type of Clinical Study or Trial: | Systematic review and/or meta-analysis |
Appears in Collections: | Articles |
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