Intravascular ultrasound guidance reduces cardiac death and coronary revascularization in patients undergoing drug-eluting stent implantation: results from a meta-analysis of 9 randomized trials and 4724 patients

  • Xiao-Fei Gao
  • Zhi-Mei Wang
  • Feng Wang
  • Yue Gu
  • Zhen Ge
  • Xiang-Quan Kong
  • Guang-Feng Zuo
  • Jun-Jie ZhangEmail author
  • Shao-Liang ChenEmail author
Original Paper


Intravascular ultrasound (IVUS) guidance is not routinely performed in real-word clinical practice partly because the benefit of IVUS guidance is not well established. This updated meta-analysis aims to compare IVUS-guided and angiography-guided drug-eluting stent (DES) implantation, simultaneously stressing the value of an optimal IVUS-defined procedure. Medline, Scopus, Google Scholar, and Cochrane Controlled Trials Registry were searched for the randomized trials comparing IVUS-guided and angiography-guided DES implantation. Nine eligible randomized trials including 4,724 patients were identified. At a mean follow-up of 16.7 months, IVUS guidance was associated with a significant lower risk of major adverse cardiovascular events (MACE) [5.4% vs. 9.0%; relative risks (RR): 0.61, 95% confident interval (CI) 0.49–0.74, p < 0.001], cardiac death (0.6% vs. 1.2%; RR: 0.49, 95% CI 0.26–0.92, p = 0.03), target vessel revascularization (3.5% vs .6.1%; RR: 0.58, 95% CI 0.42–0.80, p = 0.001), target lesion revascularization (3.1% vs. 5.2%; RR: 0.59, 95% CI 0.44–0.80, p = 0.001), and definite/probable stent thrombosis (0.5% vs .1.1%; RR: 0.45, 95% CI 0.23–0.87, p = 0.02) compared with angiography guidance. No significant differences in all cause death and myocardial infarction were noted between the two groups. Subgroup analysis showed that patients who met the optimal criteria had a lower rate of MACE than those with IVUS-defined suboptimal procedure (RR: 0.33, 95% CI 0.06–0.60, p = 0.02). The present meta-analysis with the largest sample size to date demonstrates that IVUS-guided DES implantation significantly reduces cardiac death, coronary revascularization and stent thrombosis, particularly for patients with IVUS-defined optimal procedures compared with angiography guidance.


Intravascular ultrasound Angiography Drug-eluting stents Optimal criteria Meta-analysis 



The present study was supported by the National Natural Science Foundation of China (NSFC 81270191, NSFC 91439118, and NSFC 91639303) and was jointly supported by Six Talent Peaks Project in Jiangsu Province (2014-WSN-058), Nanjing Health and Family Planning Commission (YKK16124), Nanjing Health Youth Talent Training project (QRX17017), and Nanjing Municipal Commission of Science & Technology (201715026).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

10554_2019_1555_MOESM1_ESM.tif (691 kb)
Supplementary material 1 Supplement Figure 1. Study flowchart. (TIF 691 KB)
10554_2019_1555_MOESM2_ESM.tif (365 kb)
Supplementary material 2 Supplement Figure 2. Funnel plot of publication bias for major adverse cardiovascular events (MACE) (A), cardiac death (B), all cause death (C), myocardial infarction (D), target vessel revascularization (TVR) (E), target lesion revascularization (TLR) (F), and stent thrombosis (G). (TIF 365 KB)
10554_2019_1555_MOESM3_ESM.tif (1.6 mb)
Supplementary material 3 Supplement Figure 3. Sensitivity analysis of MACE by omitting a single study from the overall analysis one at a time. (TIF 1671 KB)
10554_2019_1555_MOESM4_ESM.docx (154 kb)
Supplementary material 4 (DOCX 154 KB)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Xiao-Fei Gao
    • 1
    • 2
  • Zhi-Mei Wang
    • 1
  • Feng Wang
    • 1
  • Yue Gu
    • 1
  • Zhen Ge
    • 1
  • Xiang-Quan Kong
    • 1
  • Guang-Feng Zuo
    • 1
  • Jun-Jie Zhang
    • 1
    • 2
    Email author
  • Shao-Liang Chen
    • 1
    • 2
    Email author
  1. 1.Department of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
  2. 2.Department of CardiologyNanjing Heart CentreNanjingChina

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