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Meta-Analysis
. 2021 Oct 15:2021:6082581.
doi: 10.1155/2021/6082581. eCollection 2021.

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

Qun Zhang  1   2   3   4 , Bailu Wang  5 , Yu Han  1   2   3   4 , Shukun Sun  1   2   3   4 , Ruijuan Lv  1   2   3   4 , Shujian Wei  1   2   3   4
Affiliations
Meta-Analysis

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

Qun Zhang et al. J Interv Cardiol. .

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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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
The flowchart of literature retrieval.
Figure 2
Figure 2
The forest plots of MACEs, TLR, and TVR in 30 days. MI: myocardial infarction; TLR: target lesion revascularization; TVR: target vessel revascularization; ST: stent thrombosis; MACEs: major adverse cardiovascular events.
Figure 3
Figure 3
The forest plots of MACEs, TLR, and TVR in 1 year. MACEs: major adverse cardiovascular events.
Figure 4
Figure 4
The forest plots of MACEs, TLR, and TVR in 2 years. ST: stent thrombosis; MI: myocardial infarction; TLR: target lesion revascularization; TVR: target vessel revascularization; MACEs: major adverse cardiovascular events.
Figure 5
Figure 5
The forest plots of MACEs, TLR, and TVR in 3 years. MACEs: major adverse cardiovascular events; TVR: target vessel revascularization; TLR: target lesion revascularization.
Figure 6
Figure 6
In patients with long coronary lesions, the forest plots of MACEs in 1 year. MACEs: major adverse cardiovascular events; MI: myocardial infarction; ST: stent thrombosis.
Figure 7
Figure 7
In patients with left main artery disease, the forest plots of MACEs in 1 year. TLR: target lesion revascularization; MI: myocardial infarction; TVR: target vessel revascularization; ST: stent thrombosis; MACEs: major adverse cardiovascular events.
Figure 8
Figure 8
In patients with left main artery disease, the forest plots of MACEs, TLR, and TVR in 3 years. TLR: target lesion revascularization; TVR: target vessel revascularization; MACEs: major adverse cardiovascular events.
Figure 9
Figure 9
The funnel plots of MI (30 days), ST (1 year), MI (1 year), cardiac death (1 year), TLR (1 year), TVR (1 year), all-cause death (1 year), and MACEs (1 year). TLR: target lesion revascularization; TVR: target vessel revascularization; MACEs: major adverse cardiovascular events.
Figure 10
Figure 10
Begg's funnel plot of MI (30 days), MI (1 year), cardiac death (1 year), and MACEs (1 year). MI: myocardial infarction; MACEs: major adverse cardiovascular events.
See this image and copyright information in PMC

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