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Meta-Analysis
. 2013 Aug;101(2):106-16.
doi: 10.5935/abc.20130131. Epub 2013 Jul 2.

Angioplasty guided by intravascular ultrasound: meta-analysis of randomized clinical trials

[Article in English, Portuguese]
José Albuquerque de Figueiredo Neto, Iara Antonia Lustosa Nogueira, Mabel Fernandes Figueiro, Anna Maria Buehler, Otavio Berwanger
Meta-Analysis

Angioplasty guided by intravascular ultrasound: meta-analysis of randomized clinical trials

[Article in English, Portuguese]
José Albuquerque de Figueiredo Neto et al. Arq Bras Cardiol. 2013 Aug.

Abstract

Background: The impact of intravascular ultrasound (IVUS) use on stenting has shown inconclusive results.

Objective: Systematic review and meta-analysis of the impact of IVUS on stenting regarding the clinical and angiographic evolution.

Methods: A search was performed in Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus and Web of Science databases. It included randomized clinical trials (RCTs) that evaluated the implantation of stents guided by IVUS, compared with those using angiography alone (ANGIO). The minimum follow-up duration was six months and the following outcomes were assessed: thrombosis, mortality, myocardial infarction, percutaneous and surgical revascularization, major adverse cardiovascular events (MACE) and restenosis. The binary outcomes were presented considering the number of events in each group; the estimates were generated by a random effects model, considering Mantel-Haenszel statistics as weighting agent and magnitude of effect for the relative risk (RR) with its respective 95% confidence interval (95%CI). Higgins I² test was used to quantify the consistency between the results of each study.

Results: A total of 2,689 articles were evaluated, including 8 RCTs. There was a 27% reduction in angiographic restenosis (RR: 0.73, 95% CI: 0.54-0.97, I² = 51%) and statistically significant reduction in the rates of percutaneous revascularization and overall (RR: 0.88; 95% CI: 0.51 to 1.53, I² = 61%, RR: 0.73, 95% CI: 0.54 to 0.99, I² = 55%), with no statistical difference in surgical revascularization (RR: 0.95, 95% CI: 0.52-1.74, I² = 0%) in favor of IVUS vs. ANGIO. There were no differences regarding the other outcomes in the comparison between the two strategies.

Conclusion: Angioplasty with stenting guided by IVUS decreases the rates of restenosis and revascularization, with no impact on MACE, acute myocardial infarction, mortality or thrombosis outcomes.

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Conflict of interest statement

Potential Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Flowchart of included studies.
Figure 2
Figure 2
Meta-analysis of angioplasties guided or not by IVUS, on the death outcome, with inclusion of all studies.
Figure 3
Figure 3
Meta-analysis of angioplasties guided or not by IVUS, on the acute myocardial infarction outcome, with inclusion of seven studies.
Figure 4
Figure 4
Meta-analysis of angioplasties guided or not by IVUS, on the revascularization outcome, with inclusion of seven studies.
Figure 5
Figure 5
Meta-analysis of angioplasties guided or not by IVUS, on the MACE outcome, with inclusion of seven studies.
Figure 6
Figure 6
Meta-analysis of angioplasties guided or not by IVUS, on the thrombosis outcome, with inclusion of two studies
Figure 7
Figure 7
Meta-analysis of angioplasties guided or not by IVUS, on the restenosis outcome, with inclusion of six studies. Angio: angiography.
See this image and copyright information in PMC

References

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