Meta-analysis and systematic review of intravascular ultrasound versus angiography-guided drug eluting stent implantation in left main coronary disease in 4592 patients
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TLDR
Compared to angiographic guidance, IVUS-guided DES implantation was associated with better clinical outcomes for patients with LMCA lesions, especially hard endpoints of death, myocardial infarction, and stent thrombosis.Abstract:
Although several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset. We performed a meta-analysis to compare clinical outcomes of IVUS versus conventional angiography guidance during implantation of DES for patients with LMCA disease. Pubmed, Cochrane Library, Embase were searched. A total of 1002 publications were reviewed; and finally, seven clinical studies - one prospective randomized controlled trial and six observational studies with 4592 patients (1907 IVUS-guided and 2685 angiography-guided) - were included in the meta-analysis. IVUS guidance was associated with a significant reduction in major adverse cardiac events (relative ratio [RR] 95% CI 0.61; 95% confidence interval [CI] 0.53 to 0.70; P < 0.001), all-cause death (RR 0.55; 95% CI 0.42 to 0.71; P < 0.001), cardiac death (RR 0.45; 95% CI 0.32 to 0.62; P < 0.001), myocardial infarction (RR 0.66; 95% CI 0.55 to 0.80; P < 0.001), and stent thrombosis (RR 0.48; 95% CI 0.27 to 0.84; P = 0.01) compared with angiographic guidance. However, there was no significant difference regarding target lesion revascularization (RR 0.60; 95% CI 0.31 to 1.18; P = 0.099) and target vessel revascularization (RR 0.64; 95% CI 0.26 to 1.56; P = 0. 322). Compared to angiographic guidance, IVUS-guided DES implantation was associated with better clinical outcomes for patients with LMCA lesions, especially hard endpoints of death, myocardial infarction, and stent thrombosis.read more
Citations
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Journal ArticleDOI
Intravascular Ultrasound Imaging-Guided Versus Coronary Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.
Fahed Darmoch,M. Chadi Alraies,Yasser Al-Khadra,Homam Moussa Pacha,Duane S. Pinto,Eric A. Osborn +5 more
TL;DR: Compared with standard CA‐guided PCI, the use of IVUS imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis.
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Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database
Tim Kinnaird,Thomas E. Johnson,Richard Anderson,Sean Gallagher,Alex Sirker,Peter Ludman,Mark A. de Belder,Samuel Copt,Keith G. Oldroyd,Adrian P. Banning,Mamas A. Mamas,Nick Curzen +11 more
TL;DR: The observed lower mortality with use of intravascular imaging to guide uLMS PCI justifies the undertaking of a large-scale randomized trial.
Journal ArticleDOI
Intravascular ultrasound guidance improves patient survival (mortality) after drug-eluting stent implantation: review and updated bibliography
TL;DR: Individual studies IVUS vs angiography-guided DES implantation studies, whether randomized clinical trials or registries are underpowered, showed that IVUS guidance reduced mortality and improved patient survival, even with second-generation DES.
Journal ArticleDOI
When to use intravascular ultrasound or optical coherence tomography during percutaneous coronary intervention
TL;DR: A review of intravascular ultrasound and optical coherence tomography during percutaneous coronary intervention compares and contrasts the key aspects of these imaging modalities.
References
More filters
Journal ArticleDOI
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
Julian P T Higgins,Douglas G. Altman,Peter C Gøtzsche,Peter Jüni,David Moher,Andrew D Oxman,Jelena Savović,Kenneth F. Schulz,Laura Weeks,Jonathan A C Sterne +9 more
TL;DR: The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate.
The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses
TL;DR: The Newcastle-Ottawa Scale (NOS) as discussed by the authors was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results.
Journal ArticleDOI
Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease
Gregg W. Stone,Joseph F. Sabik,Patrick W. Serruys,Charles A. Simonton,Philippe Généreux,John D. Puskas,David E. Kandzari,Marie Claude Morice,Nicholas Lembo,W. Morris Brown,David P. Taggart,Adrian P. Banning,Béla Merkely,Ferenc Horkay,Piet W. Boonstra,Ad J. van Boven,Imre Ungi,Gábor Bogáts,Samer Mansour,Nicolas Noiseux,Manel Sabaté,José L. Pomar,Mark Hickey,Anthony H. Gershlick,Paweł Buszman,Andrzej Bochenek,Erick Schampaert,Pierre Pagé,Ovidiu Dressler,Ioanna Kosmidou,Roxana Mehran,Stuart J. Pocock,A. Pieter Kappetein +32 more
TL;DR: In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment, PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death, stroke, or myocardial infarction at 3 years.
Journal ArticleDOI
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 S. Mintz,Yi-ming Yang,Issam Moussa,Giora Weisz,George Dangas,Roxana Mehran,Alexandra J. Lansky,Edward M. Kreps,Michael B. Collins,Gregg W. Stone,Jeffrey W. Moses,Martin B. Leon +13 more
TL;DR: In this article, the predictors of stent thrombosis after sirolimus-eluting stent (SES) implantation were determined. But, their results were limited to 15 patients who developed STC after successful SES implantation.
Journal ArticleDOI
Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial.
Timo H. Mäkikallio,Niels Ramsing Holm,Mitchell Lindsay,Mark S. Spence,Andrejs Erglis,Ian B. A. Menown,Thor Trovik,Markku Eskola,Hannu Romppanen,Thomas Kellerth,Jan Ravkilde,Lisette Okkels Jensen,Gintaras Kalinauskas,Rikard Linder,Markku O. Pentikäinen,Anders Hervold,Adrian P. Banning,Azfar Zaman,Jamen Cotton,Erlend Eriksen,Sulev Margus,Henrik Toft Sørensen,Henrik Toft Sørensen,Per Hostrup Nielsen,Matti Niemelä,Kari Kervinen,Jens Flensted Lassen,Michael Maeng,Keith G. Oldroyd,Geoff Berg,Simon J Walsh,Colm G. Hanratty,Indulis Kumsars,Peteris Stradins,Terje K. Steigen,Ole Fröbert,Alastair N J Graham,Petter C Endresen,Matthias Corbascio,Olli A. Kajander,Uday Trivedi,Juha Hartikainen,Vesa Anttila,David Hildick-Smith,Leif Thuesen,Evald Høj Christiansen +45 more
TL;DR: In this article, the authors compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for the treatment of left main coronary artery disease.
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