Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients

Dong Ho Shin; Sung Jin Hong; Gary S. Mintz; Jung Sun Kim; Byeong Keuk Kim; Young Guk Ko; Donghoon Choi; Yangsoo Jang; Myeong Ki Hong

doi:10.1016/j.jcin.2016.07.021

Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients

Dong Ho Shin, Sung Jin Hong, Gary S. Mintz, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong Ki Hong

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

46 Citations (Scopus)

Abstract

Objectives The aim of this study was to evaluate the clinical usefulness of intravascular ultrasound (IVUS)–guided new-generation drug-eluting stent (DES) implantation using a meta-analysis of individual patient–level data from randomized trials. Background Published randomized trials that compare IVUS-guided versus angiography-guided new-generation DES implantation are scarce. Methods Searches of the MEDLINE, Embase, and Cochrane databases were performed to find randomized trials that compared IVUS-guided versus angiography-guided new-generation DES implantation. A total of 2,345 patients from 3 randomized trials were identified, and all patients were treated for long lesions or chronic total occlusions. Individual patient–level data were obtained. The primary endpoint was a major adverse cardiac event, a composite of cardiac death, myocardial infarction, or stent thrombosis. An intention-to-treat analysis and per protocol analysis were performed. Results By 1 year post-procedure, major adverse cardiac events had occurred in 0.4% of the patients who underwent IVUS-guided DES implantation versus 1.2% of those who underwent angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided group, favorable clinical outcomes were observed for myocardial infarction (0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI: 0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance, IVUS-guided new-generation DES implantation was associated with favorable outcomes in terms of major adverse cardiac events, the composite of cardiac death, myocardial infarction, or stent thrombosis. These findings must be interpreted only for complex lesions, because all identified patients had long lesions or chronic total occlusions.

Original language	English
Pages (from-to)	2232-2239
Number of pages	8
Journal	JACC: Cardiovascular Interventions
Volume	9
Issue number	21
DOIs	https://doi.org/10.1016/j.jcin.2016.07.021
Publication status	Published - 2016 Nov 14

Bibliographical note

Funding Information:
This study was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare, South Korea (Nos. A085136 and HI15C1277), the Mid-Career Researcher Program through an NRF grant funded by the MEST, South Korea (No. 2015R1A2A2A01002731), and the Cardiovascular Research Center (Seoul, South Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2016 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1016/j.jcin.2016.07.021

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Shin, D. H., Hong, S. J., Mintz, G. S., Kim, J. S., Kim, B. K., Ko, Y. G., Choi, D., Jang, Y., & Hong, M. K. (2016). Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients. JACC: Cardiovascular Interventions, 9(21), 2232-2239. https://doi.org/10.1016/j.jcin.2016.07.021

Shin, Dong Ho ; Hong, Sung Jin ; Mintz, Gary S. ; Kim, Jung Sun ; Kim, Byeong Keuk ; Ko, Young Guk ; Choi, Donghoon ; Jang, Yangsoo ; Hong, Myeong Ki. / Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation : Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 21. pp. 2232-2239.

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title = "Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients",

abstract = "Objectives The aim of this study was to evaluate the clinical usefulness of intravascular ultrasound (IVUS)–guided new-generation drug-eluting stent (DES) implantation using a meta-analysis of individual patient–level data from randomized trials. Background Published randomized trials that compare IVUS-guided versus angiography-guided new-generation DES implantation are scarce. Methods Searches of the MEDLINE, Embase, and Cochrane databases were performed to find randomized trials that compared IVUS-guided versus angiography-guided new-generation DES implantation. A total of 2,345 patients from 3 randomized trials were identified, and all patients were treated for long lesions or chronic total occlusions. Individual patient–level data were obtained. The primary endpoint was a major adverse cardiac event, a composite of cardiac death, myocardial infarction, or stent thrombosis. An intention-to-treat analysis and per protocol analysis were performed. Results By 1 year post-procedure, major adverse cardiac events had occurred in 0.4% of the patients who underwent IVUS-guided DES implantation versus 1.2% of those who underwent angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided group, favorable clinical outcomes were observed for myocardial infarction (0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI: 0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance, IVUS-guided new-generation DES implantation was associated with favorable outcomes in terms of major adverse cardiac events, the composite of cardiac death, myocardial infarction, or stent thrombosis. These findings must be interpreted only for complex lesions, because all identified patients had long lesions or chronic total occlusions.",

author = "Shin, {Dong Ho} and Hong, {Sung Jin} and Mintz, {Gary S.} and Kim, {Jung Sun} and Kim, {Byeong Keuk} and Ko, {Young Guk} and Donghoon Choi and Yangsoo Jang and Hong, {Myeong Ki}",

note = "Funding Information: This study was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare, South Korea (Nos. A085136 and HI15C1277), the Mid-Career Researcher Program through an NRF grant funded by the MEST, South Korea (No. 2015R1A2A2A01002731), and the Cardiovascular Research Center (Seoul, South Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

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day = "14",

doi = "10.1016/j.jcin.2016.07.021",

language = "English",

volume = "9",

pages = "2232--2239",

journal = "JACC: Cardiovascular Interventions",

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Shin, DH, Hong, SJ, Mintz, GS, Kim, JS, Kim, BK, Ko, YG, Choi, D , Jang, Y & Hong, MK 2016, 'Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients', JACC: Cardiovascular Interventions, vol. 9, no. 21, pp. 2232-2239. https://doi.org/10.1016/j.jcin.2016.07.021

Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation : Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients. / Shin, Dong Ho; Hong, Sung Jin; Mintz, Gary S.; Kim, Jung Sun; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon ; Jang, Yangsoo ; Hong, Myeong Ki.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 21, 14.11.2016, p. 2232-2239.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation

T2 - Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients

AU - Shin, Dong Ho

AU - Hong, Sung Jin

AU - Mintz, Gary S.

AU - Kim, Jung Sun

AU - Kim, Byeong Keuk

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Jang, Yangsoo

AU - Hong, Myeong Ki

N1 - Funding Information: This study was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare, South Korea (Nos. A085136 and HI15C1277), the Mid-Career Researcher Program through an NRF grant funded by the MEST, South Korea (No. 2015R1A2A2A01002731), and the Cardiovascular Research Center (Seoul, South Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2016 American College of Cardiology Foundation

PY - 2016/11/14

Y1 - 2016/11/14

N2 - Objectives The aim of this study was to evaluate the clinical usefulness of intravascular ultrasound (IVUS)–guided new-generation drug-eluting stent (DES) implantation using a meta-analysis of individual patient–level data from randomized trials. Background Published randomized trials that compare IVUS-guided versus angiography-guided new-generation DES implantation are scarce. Methods Searches of the MEDLINE, Embase, and Cochrane databases were performed to find randomized trials that compared IVUS-guided versus angiography-guided new-generation DES implantation. A total of 2,345 patients from 3 randomized trials were identified, and all patients were treated for long lesions or chronic total occlusions. Individual patient–level data were obtained. The primary endpoint was a major adverse cardiac event, a composite of cardiac death, myocardial infarction, or stent thrombosis. An intention-to-treat analysis and per protocol analysis were performed. Results By 1 year post-procedure, major adverse cardiac events had occurred in 0.4% of the patients who underwent IVUS-guided DES implantation versus 1.2% of those who underwent angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided group, favorable clinical outcomes were observed for myocardial infarction (0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI: 0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance, IVUS-guided new-generation DES implantation was associated with favorable outcomes in terms of major adverse cardiac events, the composite of cardiac death, myocardial infarction, or stent thrombosis. These findings must be interpreted only for complex lesions, because all identified patients had long lesions or chronic total occlusions.

AB - Objectives The aim of this study was to evaluate the clinical usefulness of intravascular ultrasound (IVUS)–guided new-generation drug-eluting stent (DES) implantation using a meta-analysis of individual patient–level data from randomized trials. Background Published randomized trials that compare IVUS-guided versus angiography-guided new-generation DES implantation are scarce. Methods Searches of the MEDLINE, Embase, and Cochrane databases were performed to find randomized trials that compared IVUS-guided versus angiography-guided new-generation DES implantation. A total of 2,345 patients from 3 randomized trials were identified, and all patients were treated for long lesions or chronic total occlusions. Individual patient–level data were obtained. The primary endpoint was a major adverse cardiac event, a composite of cardiac death, myocardial infarction, or stent thrombosis. An intention-to-treat analysis and per protocol analysis were performed. Results By 1 year post-procedure, major adverse cardiac events had occurred in 0.4% of the patients who underwent IVUS-guided DES implantation versus 1.2% of those who underwent angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided group, favorable clinical outcomes were observed for myocardial infarction (0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI: 0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance, IVUS-guided new-generation DES implantation was associated with favorable outcomes in terms of major adverse cardiac events, the composite of cardiac death, myocardial infarction, or stent thrombosis. These findings must be interpreted only for complex lesions, because all identified patients had long lesions or chronic total occlusions.

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Shin DH, Hong SJ, Mintz GS, Kim JS, Kim BK, Ko YG et al. Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient–Level Data From 2,345 Randomized Patients. JACC: Cardiovascular Interventions. 2016 Nov 14;9(21):2232-2239. https://doi.org/10.1016/j.jcin.2016.07.021