Meta-Analysis of Randomized Studies Comparing Intravascular Ultrasound Versus Angiographic Guidance of Percutaneous Coronary Intervention in Pre–Drug-Eluting Stent Era
We conducted a formal meta-analysis of peer-reviewed, published, randomized studies comparing intravascular ultrasound (IVUS)-guidance and angiographic-guided bare metal stent implantation. A total of 8 studies were identified. Because the Balloon Equivalent to Stent (BEST) study was a noninferiorit...
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| Veröffentlicht in: | The American journal of cardiology 2011-02, Vol.107 (3), p.374-382 |
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| creator | Parise, Helen, ScD Maehara, Akiko, MD Stone, Gregg W., MD Leon, Martin B., MD Mintz, Gary S., MD |
| description | We conducted a formal meta-analysis of peer-reviewed, published, randomized studies comparing intravascular ultrasound (IVUS)-guidance and angiographic-guided bare metal stent implantation. A total of 8 studies were identified. Because the Balloon Equivalent to Stent (BEST) study was a noninferiority trial designed to compare 2 very different percutaneous coronary intervention strategies—IVUS-guided aggressive balloon angioplasty (with bail-out stenting) and angiographic-guided deliberate bare metal stent implantation—it was eliminated. An unadjusted random-effects meta-analysis was used to compare the IVUS-guided and non–IVUS-guided stenting in the 7 remaining studies. A total of 2,193 patients were randomized in 5 multicenter and 2 single-center studies. IVUS guidance was associated with a significantly larger postprocedure angiographic minimum lumen diameter. The mean difference was 0.12 mm (95% confidence interval [CI] 0.06 to 0.18, p |
| doi_str_mv | 10.1016/j.amjcard.2010.09.030 |
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A total of 8 studies were identified. Because the Balloon Equivalent to Stent (BEST) study was a noninferiority trial designed to compare 2 very different percutaneous coronary intervention strategies—IVUS-guided aggressive balloon angioplasty (with bail-out stenting) and angiographic-guided deliberate bare metal stent implantation—it was eliminated. An unadjusted random-effects meta-analysis was used to compare the IVUS-guided and non–IVUS-guided stenting in the 7 remaining studies. A total of 2,193 patients were randomized in 5 multicenter and 2 single-center studies. IVUS guidance was associated with a significantly larger postprocedure angiographic minimum lumen diameter. The mean difference was 0.12 mm (95% confidence interval [CI] 0.06 to 0.18, p <0.0001). IVUS guidance was also associated with a significantly lower rate of 6-month angiographic restenosis (22% vs 29%, odds ratio 0.64, 95% CI 0.42 to 0.96, p = 0.02), a significant reduction in the revascularization rate (13% vs 18%, odds ratio 0.66, 95% CI 0.48 to 0.91, p = 0.004), and overall major adverse cardiac events (19% vs. 23%, odds ratio 0.69, 95% CI 0.49 to 0.97, p = 0.03). However, no significant effect was seen for myocardial infarction (p = 0.51) or mortality (p = 0.18). In conclusion, IVUS guidance for bare metal stent implantation improved the acute procedural results (angiographic minimum lumen diameter) and thereby reduced angiographic restenosis and repeat revascularization and major adverse cardiac events, with a neutral effect on death and myocardial infarction during a follow-up period of 6 months to 2.5 years.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2010.09.030</identifier><identifier>PMID: 21257001</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Blood Vessel Prosthesis Implantation - methods ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular system ; Comparative analysis ; Coronary Angiography ; Coronary Restenosis - prevention & control ; Diseases of the cardiovascular system ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical imaging ; Medical sciences ; Meta-analysis ; Middle Aged ; Mortality ; Multicenter Studies as Topic ; Myocardial Infarction - prevention & control ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Stents ; Transplants & implants ; Ultrasonic imaging ; Ultrasonography, Interventional</subject><ispartof>The American journal of cardiology, 2011-02, Vol.107 (3), p.374-382</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Feb 1, 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c504t-90b1cfd7ff2a92fb0da1a1ff584d2217955f29ae2f06c0466d76d8d53dd6a9f63</citedby><cites>FETCH-LOGICAL-c504t-90b1cfd7ff2a92fb0da1a1ff584d2217955f29ae2f06c0466d76d8d53dd6a9f63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914910019776$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23960520$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21257001$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Maehara, Akiko, MD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><creatorcontrib>Leon, Martin B., MD</creatorcontrib><creatorcontrib>Mintz, Gary S., MD</creatorcontrib><title>Meta-Analysis of Randomized Studies Comparing Intravascular Ultrasound Versus Angiographic Guidance of Percutaneous Coronary Intervention in Pre–Drug-Eluting Stent Era</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>We conducted a formal meta-analysis of peer-reviewed, published, randomized studies comparing intravascular ultrasound (IVUS)-guidance and angiographic-guided bare metal stent implantation. A total of 8 studies were identified. Because the Balloon Equivalent to Stent (BEST) study was a noninferiority trial designed to compare 2 very different percutaneous coronary intervention strategies—IVUS-guided aggressive balloon angioplasty (with bail-out stenting) and angiographic-guided deliberate bare metal stent implantation—it was eliminated. An unadjusted random-effects meta-analysis was used to compare the IVUS-guided and non–IVUS-guided stenting in the 7 remaining studies. A total of 2,193 patients were randomized in 5 multicenter and 2 single-center studies. IVUS guidance was associated with a significantly larger postprocedure angiographic minimum lumen diameter. The mean difference was 0.12 mm (95% confidence interval [CI] 0.06 to 0.18, p <0.0001). IVUS guidance was also associated with a significantly lower rate of 6-month angiographic restenosis (22% vs 29%, odds ratio 0.64, 95% CI 0.42 to 0.96, p = 0.02), a significant reduction in the revascularization rate (13% vs 18%, odds ratio 0.66, 95% CI 0.48 to 0.91, p = 0.004), and overall major adverse cardiac events (19% vs. 23%, odds ratio 0.69, 95% CI 0.49 to 0.97, p = 0.03). However, no significant effect was seen for myocardial infarction (p = 0.51) or mortality (p = 0.18). In conclusion, IVUS guidance for bare metal stent implantation improved the acute procedural results (angiographic minimum lumen diameter) and thereby reduced angiographic restenosis and repeat revascularization and major adverse cardiac events, with a neutral effect on death and myocardial infarction during a follow-up period of 6 months to 2.5 years.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Vessel Prosthesis Implantation - methods</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular system</subject><subject>Comparative analysis</subject><subject>Coronary Angiography</subject><subject>Coronary Restenosis - prevention & control</subject><subject>Diseases of the cardiovascular system</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multicenter Studies as Topic</subject><subject>Myocardial Infarction - prevention & control</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Stents</subject><subject>Transplants & implants</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Interventional</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks9uEzEQxlcIREPhEUAWEuK0wfauvesLKAqhrVRERShXy_Gf4LBrB3sdKZx4B56C1-JJ6lVCkXrpyRr7N9-M55uieI7gFEFE32ymot9IEdQUw3wH2RRW8EExQW3DSsRQ9bCYQAhxyVDNToonMW5yiBChj4sTjDBpcjQp_nzUgyhnTnT7aCPwBnwWTvne_tQKLIekrI5g7vutCNatwYUbgtiJKFMnArjuchR9cgp81SGmCGZubf06iO03K8FZsko4qUfVKx1kGoTTPo16wTsR9qOcDjvtBusdsA5cBf331-_3Ia3LRZeGseJyyM9gEcTT4pERXdTPjudpcf1h8WV-Xl5-OruYzy5LSWA9lAyukDSqMQYLhs0KKoEEMoa0tcIYNYwQg5nQ2EAqYU2paqhqFamUooIZWp0Wrw-62-B_JB0H3tsoddcdmueM1BRBWrF7ybZucNMy3GTy5R1y41PIQ88QqXFDWwgzRA6QDD7GoA3fBtvnMXEE-eg53_Cj53z0nEPGs-c578VRPK16rW6z_pmcgVdHIBsnOhOyKTb-5ypGIcGj0LsDp_N4d1YHHqXV2UBlg5YDV97e28rbOwqys87mot_1XsfbTyMeMYd8OS7ouJ8ot8mahlY3KEXliA</recordid><startdate>20110201</startdate><enddate>20110201</enddate><creator>Parise, Helen, ScD</creator><creator>Maehara, Akiko, MD</creator><creator>Stone, Gregg W., MD</creator><creator>Leon, Martin B., MD</creator><creator>Mintz, Gary S., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><scope>7QO</scope></search><sort><creationdate>20110201</creationdate><title>Meta-Analysis of Randomized Studies Comparing Intravascular Ultrasound Versus Angiographic Guidance of Percutaneous Coronary Intervention in Pre–Drug-Eluting Stent Era</title><author>Parise, Helen, ScD ; Maehara, Akiko, MD ; Stone, Gregg W., MD ; Leon, Martin B., MD ; Mintz, Gary S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c504t-90b1cfd7ff2a92fb0da1a1ff584d2217955f29ae2f06c0466d76d8d53dd6a9f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood Vessel Prosthesis Implantation - methods</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular system</topic><topic>Comparative analysis</topic><topic>Coronary Angiography</topic><topic>Coronary Restenosis - prevention & control</topic><topic>Diseases of the cardiovascular system</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multicenter Studies as Topic</topic><topic>Myocardial Infarction - prevention & control</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Stents</topic><topic>Transplants & implants</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography, Interventional</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Maehara, Akiko, MD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><creatorcontrib>Leon, Martin B., MD</creatorcontrib><creatorcontrib>Mintz, Gary S., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parise, Helen, ScD</au><au>Maehara, Akiko, MD</au><au>Stone, Gregg W., MD</au><au>Leon, Martin B., MD</au><au>Mintz, Gary S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-Analysis of Randomized Studies Comparing Intravascular Ultrasound Versus Angiographic Guidance of Percutaneous Coronary Intervention in Pre–Drug-Eluting Stent Era</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2011-02-01</date><risdate>2011</risdate><volume>107</volume><issue>3</issue><spage>374</spage><epage>382</epage><pages>374-382</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>We conducted a formal meta-analysis of peer-reviewed, published, randomized studies comparing intravascular ultrasound (IVUS)-guidance and angiographic-guided bare metal stent implantation. A total of 8 studies were identified. Because the Balloon Equivalent to Stent (BEST) study was a noninferiority trial designed to compare 2 very different percutaneous coronary intervention strategies—IVUS-guided aggressive balloon angioplasty (with bail-out stenting) and angiographic-guided deliberate bare metal stent implantation—it was eliminated. An unadjusted random-effects meta-analysis was used to compare the IVUS-guided and non–IVUS-guided stenting in the 7 remaining studies. A total of 2,193 patients were randomized in 5 multicenter and 2 single-center studies. IVUS guidance was associated with a significantly larger postprocedure angiographic minimum lumen diameter. The mean difference was 0.12 mm (95% confidence interval [CI] 0.06 to 0.18, p <0.0001). IVUS guidance was also associated with a significantly lower rate of 6-month angiographic restenosis (22% vs 29%, odds ratio 0.64, 95% CI 0.42 to 0.96, p = 0.02), a significant reduction in the revascularization rate (13% vs 18%, odds ratio 0.66, 95% CI 0.48 to 0.91, p = 0.004), and overall major adverse cardiac events (19% vs. 23%, odds ratio 0.69, 95% CI 0.49 to 0.97, p = 0.03). However, no significant effect was seen for myocardial infarction (p = 0.51) or mortality (p = 0.18). In conclusion, IVUS guidance for bare metal stent implantation improved the acute procedural results (angiographic minimum lumen diameter) and thereby reduced angiographic restenosis and repeat revascularization and major adverse cardiac events, with a neutral effect on death and myocardial infarction during a follow-up period of 6 months to 2.5 years.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21257001</pmid><doi>10.1016/j.amjcard.2010.09.030</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Blood Vessel Prosthesis Implantation - methods Cardiology. Vascular system Cardiovascular Cardiovascular system Comparative analysis Coronary Angiography Coronary Restenosis - prevention & control Diseases of the cardiovascular system Female Follow-Up Studies Heart attacks Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical imaging Medical sciences Meta-analysis Middle Aged Mortality Multicenter Studies as Topic Myocardial Infarction - prevention & control Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Stents Transplants & implants Ultrasonic imaging Ultrasonography, Interventional |
| title | Meta-Analysis of Randomized Studies Comparing Intravascular Ultrasound Versus Angiographic Guidance of Percutaneous Coronary Intervention in Pre–Drug-Eluting Stent Era |
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