TY - JOUR
T1 - Angiographic-only or intravascular ultrasound-guided approach for left-main coronary artery intervention
T2 - a systematic review and meta-analysis
AU - Saleem, Sameer
AU - Ullah, Waqas
AU - Mukhtar, Maryam
AU - Sarvepalli, Deepika
AU - Younas, Sundas
AU - Arab, Shuaib Ahmed
AU - Al Hemyari, Bashar
AU - Zahid, Salman
AU - Nazir, Salik
AU - Cheema, Tayyab
AU - Mir, Tanveer
AU - Abdul-Waheed, Mohammad
N1 - Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Introduction: The use of intravascular ultrasound (IVUS) in percutaneous revascularization of left-main coronary artery disease (LMCAD) warrants further exploration. We aimed to collate all available data on the merits of IVUS in LMCAD to help decision-making. Methods: The MEDLINE, Embase, and Cochrane databases were queried for relevant randomized controlled trials (RCTs) and observational cohort studies (OCS). The data were analyzed using random-effects model to calculate unadjusted odds ratio (OR) between IVUS-guided and angiography-only LMCA revascularization. Results: A total of 14 studies (2 RCTs and 12 OCS), comprising 18944 patients, were included. The pooled odds of all-cause mortality (OR 0.57, 95%CI 0.46–0.70, p = <0.00001), cardiovascular mortality (OR 0.37, 95%CI 0.26–0.54, p = <0.00001), left-main revascularization (OR 0.63, 95%CI 0.45–0.89, p = 0.009) and myocardial infarction (OR 0.80, 95% CI 0.66–0.97, p = 0.02) were significantly lower with IVUS-guidance. There was no difference observed in the odds of the stent thrombosis (OR 0.57, 95% CI 0.31–1.05, p = 0.07) and stroke (OR 1.7, 95%CI 0.56–5.14, p = 0.35) between the two groups. A subgroup analysis based on the study design and follow-up duration mirrored the pooled estimates. Conclusion: IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than the angiography-only approach. This needs to be tested in a large randomized controlled trial.
AB - Introduction: The use of intravascular ultrasound (IVUS) in percutaneous revascularization of left-main coronary artery disease (LMCAD) warrants further exploration. We aimed to collate all available data on the merits of IVUS in LMCAD to help decision-making. Methods: The MEDLINE, Embase, and Cochrane databases were queried for relevant randomized controlled trials (RCTs) and observational cohort studies (OCS). The data were analyzed using random-effects model to calculate unadjusted odds ratio (OR) between IVUS-guided and angiography-only LMCA revascularization. Results: A total of 14 studies (2 RCTs and 12 OCS), comprising 18944 patients, were included. The pooled odds of all-cause mortality (OR 0.57, 95%CI 0.46–0.70, p = <0.00001), cardiovascular mortality (OR 0.37, 95%CI 0.26–0.54, p = <0.00001), left-main revascularization (OR 0.63, 95%CI 0.45–0.89, p = 0.009) and myocardial infarction (OR 0.80, 95% CI 0.66–0.97, p = 0.02) were significantly lower with IVUS-guidance. There was no difference observed in the odds of the stent thrombosis (OR 0.57, 95% CI 0.31–1.05, p = 0.07) and stroke (OR 1.7, 95%CI 0.56–5.14, p = 0.35) between the two groups. A subgroup analysis based on the study design and follow-up duration mirrored the pooled estimates. Conclusion: IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than the angiography-only approach. This needs to be tested in a large randomized controlled trial.
KW - Angiography
KW - intravascular ultrasound
KW - left main coronary artery disease
KW - percutaneous coronary intervention
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U2 - 10.1080/14779072.2021.2004122
DO - 10.1080/14779072.2021.2004122
M3 - Article
C2 - 34747315
AN - SCOPUS:85119993480
SN - 1477-9072
VL - 19
SP - 1029
EP - 1035
JO - Expert Review of Cardiovascular Therapy
JF - Expert Review of Cardiovascular Therapy
IS - 11
ER -