Table 1.
Meta-analyses reporting clinical outcomes (risk reduction and 95% confidence intervals) associated with intravascular imaging–guided drug-eluting stent implantation.
| Reference, year | Study populationa | All-cause mortality | Cardiovascular mortality | MACE | Myocardial infarction | Stent thrombosis | TVR | TLR |
|---|---|---|---|---|---|---|---|---|
| IVUS vs angiography | ||||||||
| Zhang et al,37 2012 | 11 studies (1 RCT) 19,619 patients |
0.59 (0.48-0.73) | N/R | 0.87 (0.78-0.96) | 0.82 (0.63-1.06) | 0.58 (0.44-0.77) | 0.90 (0.77-1.05) | 0.90 (0.73-1.11) |
| Propensity score–matched | 5300 patients | 0.73 (0.54-0.99) | N/R | N/R | 0.63 (0.43-0.91) | 0.57 (0.39-0.84) | N/R | N/R |
| Zhang et al,38 2013 | 14 studies (3 RCTs) 29,029 patients |
0.66 (0.55-0.78) | N/R | 0.86 (0.77-0.95) | 0.74 (0.62-0.90) | 0.57 (0.44-0.73) | N/R | 0.82 (0.68-0.97) |
| Klersy et al,39 2013 | 12 studies (3 RCTs) 18,707 patients |
0.60 (0.48-0.74) | N/R | 0.80 (0.71-0.89) | 0.59 (0.44-0.80) | 0.50 (0.32-0.80) | 0.95 (0.82-1.09) | N/R |
| Jang et al,40 2014 | 15 studies (3 RCTs) 24,849 patients |
0.64 (0.51-0.81) | N/R | 0.79 (0.69-0.91) | 0.57 (0.42-0.78) | 0.59 (0.42-0.82) | 0.81 (0.68-0.95) | 0.76 (0.62-0.94) |
| Propensity score–matched | 13,545 patients | 0.58 (0.42-0.81) | N/R | 0.79 (0.66-0.95) | 0.56 (0.33-0.97) | 0.52 (0.34-0.82) | 0.93 (0.79-1.09) | 0.85 (0.64-1.13) |
| Ahn et al,41 2014 | 17 studies (3 RCTs) 26,503 patients |
0.61 (0.48-0.79) | N/R | 0.74 (0.64-0.85) | 0.57 (0.44-0.75) | 0.59 (0.47-0.75) | 0.82 (0.70-0.97) | 0.81 (0.66-1.00) |
| Zhang et al,42 2015 | 20 studies (3 RCTs) 29,068 patients |
0.62 (0.54-0.71) | N/R | 0.77 (0.71-0.83) | 0.64 (0.55-0.75) | 0.59 (0.47-0.73) | 0.86 (0.77-0.97) | 0.81 (0.69-0.94) |
| Propensity score–matched | 8331 patients | 0.64 (0.52-0.79) | N/R | 0.79 (0.70-0.88) | 0.69 (0.56-0.85) | 0.55 (0.39-0.78) | 0.82 (0.68-0.98) | 0.92 (0.76-1.11) |
| Complex lesions or patients with acute coronary syndrome | 6393 patients | 0.52 (0.40-0.67) | N/R | 0.69 (0.60-0.79) | N/R | 0.41 (0.25-0.69) | N/R | N/R |
| Steinvil et al,43 2016 | 25 studies (7 RCTs) 31,283 patients |
0.62 (0.54-0.72) | N/R | 0.76 (0.70-0.82) | 0.67 (0.56-0.80) | 0.58 (0.47-0.73) | 0.85 (0.76-0.95) | 0.77 (0.67-0.89) |
| Complex lesions (LMCA, bifurcations, CTO) | 13 studies | 0.52 (0.41-0.67) | N/R | 0.70 (0.61-0.80) | 0.72 (0.57-0.92) | 0.32 (0.18-0.57) | 0.62 (0.45-0.84) | 0.76 (0.57-1.01) |
| Propensity score–matched and RCT reports | 16 studies 10,486 patients |
0.65 (0.53-0.80) | N/R | 0.76 (0.68-0.85) | 0.75 (0.62-0.90) | 0.55 (0.39-0.76) | 0.80 (0.67-0.94) | 0.84 (0.70-1.00) |
| Randomized controlled trials | 7 RCTs 3192 patients |
0.81 (0.44-1.47) | N/R | 0.66 (0.52-0.84) | 1.04 (0.68-1.59) | 0.71 (0.28-1.78) | 0.61 (0.41-0.90) | 0.61 (0.43-0.87) |
| Elgendy et al,44 2016 | 7 RCTs 3275 patients |
N/R | 0.46 (0.21-1.00) | 0.60 (0.46-0.77) | 0.52 (0.26-1.02) | 0.49 (0.24-0.99) | 0.61 (0.41-0.91) | 0.60 (0.43-0.84) |
| Shin et al,45 2016 | 3 RCTs 2345 patients |
N/R | 0.38 (0.10-1.42) | 0.36 (0.13-0.99) | N/R | 0.50 (0.13-2.01) | N/R | 0.61 (0.40-0.93) |
| Nerlekar et al,46 2017 | 15 (6 RCTs) 9313 patients |
N/R | 0.55 (0.36-0.83) | 0.73 (0.64-0.85) | 0.67 (0.50-0.90) | 0.52 (0.38-0.72) | 0.79 (0.64-0.98) | 0.66 (0.52-0.84) |
| First generation DES | 11 studies (6156 patients) | N/R | 0.64 (0.39-1.04) | 0.79 (0.67-0.92) | 0.63 (0.45-0.89) | 0.56 (0.40-0.79) | 0.88 (0.70-1.11) | 0.70 (0.51-0.95) |
| Second-generation DES | 6 studies (3157 patients) | N/R | 0.33 (0.14-0.78) | 0.57 (0.43-0.77) | 0.82 (0.45-1.49) | 0.31 (0.12-0.78) | 0.47 (0.28-0.79) | 0.61 (0.42-0.90) |
| Fan et al,47 2017 | 15 studies (6 RCTs) 8084 patients |
0.52 (0.40-0.67) | N/R | 0.63 (0.53-0.73) | 0.70 (0.56-0.86) | 0.31 (0.20-0.50) | 0.53 (0.40-0.70) | 0.69 (0.50-0.94) |
| Propensity-matched studies and RCTs | 7 propensity-matched studies; 6 RCTs 6573 patients |
0.49 (0.37-0.65) | N/R | 0.67 (0.57-0.78) | 0.76 (0.60-0.97) | 0.34 (0.20-0.58) | 0.57 (0.42-0.77) | 0.79 (0.61-1.01) |
| Bavishi et al,48 2017 | 8 RCTs 3276 patients |
1.00 (0.48-2.09) | 0.51 (0.23-1.12) | 0.64 (0.51-0.80) | 0.90 (0.58-1.41) | 0.57 (0.26-1.23) | 0.60 (0.42-0.87) | 0.62 (0.45-0.86) |
| Buccheri et al,49 2017 | Bayesian network meta-analysis of 31 studies and 17,882 patients | 0.74 (0.58-0.98) | 0.47 (0.32-0.66) | 0.79 (0.67-0.91) | 0.72 (0.52-0.93) | 0.42 (0.20-0.72) | N/R | 0.74 (0.58-0.90) |
| Räber et al,10 2018 | 8 RCTs 3276 patients |
N/R | 0.51 (0.23-1.12) | 0.64 (0.51-0.80) | 0.61 (0.32-1.16) | N/R | N/R | 0.60 (0.43-0.83) |
| di Mario et al,50 2018 | 9 RCTs 4724 patients |
N/R | 0.51 (0.27-0.96) | 0.62 (0.51-0.77) | 0.62 (0.36-1.05) | N/R | N/R | 0.58 (0.43-0.78) |
| Gao et al,51 2019 | 9 RCTs 4724 patients |
0.78 (0.46-1.31) | 0.49 (0.26-0.92) | 0.61 (0.49-0.74) | 0.79 (0.54-1.17) | 0.45 (0.23-0.87) | 0.58 (0.42-0.80) | 0.59 (0.44-0.80) |
| Elgendy et al,52 2019 | 10 RCTs 5060 patients |
N/R | 0.44 (0.26-0.75) | N/R | 0.55 (0.32-0.94) | 0.44 (0.24-0.79) | N/R | 0.57 (0.42-0.77) |
| Kumar et al,53 2019 | 11 RCTs 5352 patients |
N/R | 0.45 (0.25-0.80) | N/R | 0.83 (0.54-1.28) | 0.47 (0.24-0.94) | N/R | 0.56 (0.41-0.77) |
| Malik et al,54 2020 | 10 RCTs 5007 patients |
N/R | 0.51 (0.27-0.96) | 0.63 (0.51-0.77) | 0.86 (0.58-1.29) | 0.50 (0.24-1.04) | 0.59 (0.43-0.81) | 0.59 (0.44-0.80) |
| Darmoch et al,55 2020 | 19 (6 RCTs)b 27637 patients |
N/R | 0.63 (0.54-0.73) | N/R | 0.71 (0.58-0.86) | 0.57 (0.41-0.79) | N/R | 0.81 (0.70-0.94) |
| Pang et al,56 2020 | Bayesian network meta-analysis of 18 studies (62,197 patients) | 1.7∗e−9 (9.9e−25 to 0.24) | N/R | 0.45 (0.20-0.97) | 1.0 (0.09-11.0) | N/R | N/R | N/R |
| Zhang et al,57 2021 | 20 studies (3 RCTs) 24,783 |
0.79 (0.63-0.98) | 0.62 (0.47-0.82) | 0.65 (0.58-0.73) | 0.68 (0.57-0.80) | 0.47 (0.33-0.67) | 0.74 (0.65-0.85) | 0.67 (0.56-0.80) |
| Studies with 2-year follow-up | 5 studies | N/R | 0.62 (0.32-1.23) | 0.51 (0.36-0.71) | 0.57 (0.37-0.87) | 0.28 (0.10-0.80) | 0.79 (0.58-1.07) | 0.66 (0.39-1.12) |
| Studies with 3-year follow-up | 6 studies | 0.54 (0.36-0.81) | 0.41 (0.24-0.69) | 0.45 (0.31-0.65) | 0.64 (0.49-0.83) | 0.84 (0.43-1.61) | 0.95 (0.67-1.34) | 0.89 (0.58-1.37) |
| Groenland et al,58 2022 | 9 studies (1 RCT) 838,902 patients with myocardial infarction |
0.70 (0.59-0.82) | 0.62 (0.29-1.33) | 0.86 (0.74-0.99) | N/R | N/R | 0.83 (0.73-0.95) | N/R |
| OCT vs angiography | ||||||||
| Buccheri et al,49 2017 | Bayesian network meta-analysis of 31 studies and 17,882 patients | 0.59 (0.29-1.20) | 0.31 (0.13-0.66) | 0.68 (0.49-0.97) | 0.79 (0.44-1.40) | 0.39 (0.10-1.20) | N/R | 0.66 (0.35-1.20) |
| Kuku et al,59 2018 | 6 studies and 2781 patients (OCT vs Angio-guidance: 1753 patients) | N/R | 0.40 (0.18-0.90) | 0.70 (0.49-1.00) | 0.70 (0.42-1.16) | 1.17 (0.40-3.43) | N/R | 1.07 (0.48-2.38) |
| Sharma et al,60 2019 | 5 RCTs 931 patients |
3.03 (0.12-75.0) | N/R | N/R | 2.21 (0.39-12.49) | 0.70 (0.11-4.51) | 1.36 (0.40-4.40) | N/R |
| Pang et al,56 2020 | Bayesian network meta-analysis of 18 studies (62,197 patients) | 0.88 (0.24-2.80) | N/R | 0.89 (0.45-1.50) | 0.87 (0.28-2.00) | N/R | N/R | N/R |
| LMCA intervention (IVUS vs angiography) | ||||||||
| Ye et al,61 2017 | 10 studies (1 RCT) 6480 patients |
0.60 (0.47-0.75) | 0.47 (0.33-0.66) | N/R | 0.80 (0.61-1.06) | 0.28 (0.12-0.67) | 0.89 (0.66-1.20) | 0.43 (0.25-0.73) |
| Wang et al,62 2018 | 7 studies (1 RCT) 4592 patients |
0.55 (0.42-0.71) | 0.45 (0.32-0.62) | 0.61 (0.53-0.70) | 0.66 (0.55-0.80) | 0.48 (0.27-0.84) | 0.64 (0.26-1.56) | 0.60 (0.31-1.18) |
| Elgendy et al,63 2019 | 9 studies (2 RCTs) 4971 patients |
0.53 (0.40-0.70) | 0.40 (0.28-0.59) | N/R | 0.69 (0.50-0.96) | 0.47 (0.32-0.70) | N/R | 0.76 (0.50-1.16) |
| Elgendy et al,64 2020 | 11 studies (2 RCTs) 15,083 patients |
0.59 (0.53-0.66) | 0.39 (0.27-0.58) | N/R | 0.66 (0.48-0.90) | 0.38 (0.26-0.56) | N/R | 0.51 (0.39-0.68) |
| Saleem et al,65 2021 | 14 studies (2 RCTs) 18,944 patients |
0.57 (0.46-0.70) | 0.37 (0.26-0.54) | N/R | 0.80 (0.66-0.97) | 0.57 (0.31-1.05) | N/R | 0.63 (0.45-0.89) |
| OCT vs IVUS | ||||||||
| Buccheri et al,49 2017 | Bayesian network meta-analysis of 31 studies and 17,882 patients | 0.81 (0.41-1.60) | 0.66 (0.28-1.50) | 0.87 (0.61-1.30) | 1.10 (0.61-2.10) | 0.93 (0.23-3.60) | N/R | 0.89 (0.47-1.70) |
| Kuku et al,59 2018 | 6 studies and 2781 patients (OCT vs IVUS guidance: 1028 patients) | N/R | 0.56 (0.12-2.70) | 0.89 (0.46-1.73) | 0.56 (0.12-2.70) | 0.43 (0.06-2.95) | N/R | 0.99 (0.45-2.18) |
| Pang et al,56 2020 | Bayesian network meta-analysis of 18 studies (62,197 patients) | 1.30 (0.43-4.00) | N/R | 0.91 (0.49-1.70) | 1.60 (0.41-6.60) | N/R | N/R | N/R |
| Salesh et al,66 2021 | 4 RCTs and 3 propensity-matched observational studies (13,995 patients) | 1.05 (0.59-1.87) | N/R | 1.10 (0.69-1.74) | 1.22 (0.53-2.82) | 0.69 (0.13-3.61) | N/R | 0.88 (0.46-1.68) |
| Sattar et al,67 2021 | 7 studies (4 RCTs) 5917 patients |
0.74 (0.39-1.39) | 0.97 (0.27-3.46) | 0.78 (0.57-1.09) | 1.27 (0.52-3.07) | 0.70 (0.13-3.61) | N/R | 1.09 (0.53-2.25) |
CTO, chronic total occlusion; DES, drug-eluting stent; IVUS, intravascular ultrasound; LMCA, left main coronary artery; MACE, major adverse cardiac events; N/R, not reported; OCT, optical coherence tomography; RCT, randomized controlled trial; TLR, target lesion revascularization; TVR, target vessel revascularization.
a
Presented as the total number of studies (randomized controlled trials).
b
From the 19 included studies, 16 (84.2%) studies used DES; however, the clinical outcomes results are presented for the overall population only, with no separation for bare metal stent and DES.