期刊
AMERICAN HEART JOURNAL
卷 185, 期 -, 页码 26-34出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.ahj.2016.10.008
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Background The relative outcomes of intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI with drug-eluting stent (DES) in complex lesions have not been established. We sought to compare the efficacy and safety of IVUS-guided PCI with angiography-guided PCI in patients with complex coronary lesions treated with DES. Methods Electronic databases were searched to identify all randomized trials comparing IVUS-guided vs angiographyguided DES implantation. We evaluated major adverse cardiac events (MACE), all-cause and cardiovascular death, myocardial infarction, target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis outcomes at the longest reported follow-up. Random-effects modeling was used to calculate pooled relative risk (RR) and 95% Cls. Results Eight trials comprising 3,276 patients (1,635 IVUS-guided and 1,641 angiography-guided) enrolling only patients with complex lesions were included. Mean follow-up was 1.4 +/- 0.5 years. Compared with angiography-guided PCI, patients undergoing IVUS-guided PCI had significantly lower MACE (RR 0.64, 95% CI 0.51-0.80, P = .0001), TLR (RR 0.62, 95% CI 0.45-0.86, P = .004), and TVR (RR 0.60, 95% CI 0.42-0.87, P = .007). There were no significant differences for stent thrombosis, cardiovascular death, or all-cause death. In meta-regression analysis, IVUS-guided PCI was of greatest benefit in reducing MACE in patients with acute coronary syndromes, diabetes, and long lesions. Conclusions The present meta-analysis demonstrates a significant reduction in MACE, TVR, and TLR with IVUS-guided DES implantation in complex coronary lesions.
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