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      Short- and Long-Term Prognosis of Intravascular Ultrasound-Versus Angiography-Guided Percutaneous Coronary Intervention: A Meta-Analysis Involving 24,783 Patients

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          Abstract

          Background

          Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) has potential benefits. This meta-analysis aimed to explore whether IVUS-guided PCI had better short- and long-term prognoses than angiography-guided PCI.

          Methods

          We retrieved studies from PubMed, Embase, and Cochrane Library. Clinical trials including retrospective and randomized controlled trials (RCTs) that compared IVUS-guided PCI with angiography-guided PCI were included. The patients were followed up after operation at 30 days, 1 year, 2 years, and 3 years. The clinical outcomes were target lesion revascularization (TLR), target vessel revascularization (TVR), and MACEs, including stent thrombosis (ST), myocardial infarction (MI), cardiac death, and all-cause death. The study population included patients with MI, coronary bifurcation lesions, short or long lesions, and unprotected left main coronary artery stenosis (ULMCA). The quality of retrospective trials was evaluated using the Newcastle–Ottawa Scale, and the quality of randomized controlled trials was evaluated using the Jadad score. A total of 20 clinical trials met the criteria. Three trials were randomized controlled trials, while 17 were retrospective trials.

          Results

          A total of 24,783 patients were included. In observational trials, the OR of MACEs was 0.49 (95% CI: 0.38–0.62) in 30 days, 0.65 (95% CI: 0.58–0.73) in one year, 0.51 (95% CI: 0.36–0.71) in two years, and 0.45 (95% CI: 0.31–0.65) in three years. In patients with long coronary lesions, the OR of MACEs in 1 year was 0.64 (95% CI: 0.28–1.50). In patients with left main artery disease, the OR of MACEs in 3 years was 0.42 (95% CI: 0.26–0.67). Compared with angiography-guided PCI, IVUS-guided PCI was associated with a lower incidence of MACEs during the same following period.

          Conclusion

          Compared with angiography-guided PCI, IVUS-guided PCI has better performance in reducing the occurrence of MACEs.

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          Most cited references39

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          Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial.

          Sung-Jin Hong, Byeong-Keuk Kim, Dong-Ho Shin … (2015)
          Use of intravascular ultrasound (IVUS) promotes better clinical outcomes for coronary intervention in complex coronary lesions. However, randomized data demonstrating the clinical usefulness of IVUS are limited for lesions treated with drug-eluting stents.
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            Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results

            Takashi Kubo, Toshiro Shinke, Takayuki Okamura … (2017)
            Abstract Aims Optical frequency domain imaging (OFDI) is a recently developed, light-based, high-resolution intravascular imaging technique. Intravascular ultrasound (IVUS) is a widely used, conventional imaging technique for guiding percutaneous coronary intervention (PCI). We aimed to demonstrate the non-inferiority of OFDI-guided PCI compared with IVUS-guided PCI in terms of clinical outcomes. Methods and results We did a prospective, multicentre, randomized (ratio 1:1), active-controlled, non-inferiority study to compare head-to-head OFDI vs. IVUS in patients undergoing PCI with a second generation drug-eluting stent. The primary endpoint was target vessel failure defined as a composite of cardiac death, target-vessel related myocardial infarction, and ischaemia-driven target vessel revascularization until 12 months after the PCI. The major secondary endpoint was angiographic binary restenosis at 8 months. We randomly allocated 829 patients to receive OFDI-guided PCI (n = 414) or IVUS-guided PCI (n = 415). Target vessel failure occurred in 21 (5.2%) of 401 patients undergoing OFDI-guided PCI, and 19 (4.9%) of 390 patients undergoing IVUS-guided PCI, demonstrating non-inferiority of OFDI-guided PCI to IVUS-guided PCI (hazard ratio 1.07, upper limit of one-sided 95% confidence interval 1.80; P non-inferiority = 0.042). With 89.8% angiographic follow-up, the rate of binary restenosis was comparable between OFDI-guided PCI and IVUS-guided PCI (in-stent: 1.6% vs. 1.6%, P = 1.00; and in-segment: 6.2% vs. 6.0%, P = 1.00). Conclusion The 12-month clinical outcome in patients undergoing OFDI-guided PCI was non-inferior to that of patients undergoing IVUS-guided PCI. Both OFDI-guided and IVUS-guided PCI yielded excellent angiographic and clinical results, with very low rates of 8-month angiographic binary restenosis and 12-month target vessel failure. Clinical registration ClinicalTrials.gov, number NCT01873027.
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              Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study.

              Kenichi Fujii, Stephane Carlier, Gary Mintz … (2005)
              We sought to determine the predictors of stent thrombosis after sirolimus-eluting stent (SES) implantation. A number of cases of stent thrombosis have been reported after commercial release of the SES in the "real world," such that the U.S. Food and Drug Administration issued a warning. Fifteen patients who developed stent thrombosis after successful SES implantation were analyzed and compared with 45 matched control patients who had no evidence of stent thrombosis. Minimum stent cross-sectional area (MSA) (4.3 +/- 1.6 mm(2) vs. 6.2 +/- 1.9 mm(2), p < 0.001) and stent expansion (0.65 +/- 0.18 vs. 0.85 +/- 0.14, p < 0.001) were significantly smaller in the stent thrombosis group than in the matched control patients. There was no significant difference in the rate of SES malapposition between the groups. However, the presence of a significant residual reference segment stenosis was more common in the stent thrombosis group compared with the matched control group (67% vs. 9%, p < 0.001). Independent predictors of stent thrombosis were stent underexpansion (p = 0.03) and a significant residual reference segment stenosis (p = 0.02). Stent underexpansion and residual reference segment stenosis are associated with stent thrombosis after successful SES implantation.
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                Author and article information

                Contributors
                Ruijuan Lv:
                ORCID: https://orcid.org/0000-0001-8993-6689
                Shujian Wei:
                ORCID: https://orcid.org/0000-0002-0896-6032
                Journal
                Journal ID (nlm-ta): J Interv Cardiol
                Journal ID (iso-abbrev): J Interv Cardiol
                Journal ID (publisher-id): JITC
                Title: Journal of Interventional Cardiology
                Publisher: Hindawi
                ISSN (Print): 0896-4327
                ISSN (Electronic): 1540-8183
                Publication date Collection: 2021
                Publication date (Electronic): 15 October 2021
                Volume: 2021
                Electronic Location Identifier: 6082581
                Affiliations
                1Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
                2Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
                3Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
                4The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
                5Clinical Trial Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong,250012, China
                Author notes

                Academic Editor: Joseph Dens

                Author information
                https://orcid.org/0000-0001-8993-6689
                https://orcid.org/0000-0002-0896-6032
                Article
                DOI: 10.1155/2021/6082581
                PMC ID: 8536416
                PubMed ID: 34737679
                SO-VID: 906acfa2-ddbc-4cb6-ab54-d92ab336898e
                Copyright © Copyright © 2021 Qun Zhang et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 May 2021
                Date revision received : 15 September 2021
                Date accepted : 21 September 2021
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 82072141
                Funded by: Key R & D Program of Shandong Province
                Award ID: 2019GSF108261
                Funded by: Natural Science Foundation of Shandong Province
                Award ID: ZR2020MH030
                Funded by: Shandong University
                Award ID: 2020SDUCRCC014
                Categories
                Subject: Research Article

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