Acute and one-year clinical outcomes of pre-stenting intravascular ultrasound: a patient-level meta-analysis of randomised clinical trials

Background: Pre-stenting intravascular ultrasound (IVUS) assessment is helpful for appropriate stent sizing and determination of the stent landing zone during percutaneous coronary intervention.

Aims: The aim of this meta-analysis was to investigate the effect of pre-stenting IVUS evaluation on procedural and clinical outcomes for diffuse lesions treated with drug-eluting stents (DES).

Methods: In four randomised trials comparing IVUS- and angiography-guided DES placement, a total of 1,396 patients who underwent DES implantation with IVUS guidance were identified. Pre-stenting IVUS assessment was performed in 905 patients along with post-stenting IVUS (65%; pre-stenting IVUS(+) group). Post-stenting IVUS evaluation alone was conducted on 491 patients (35%; pre-stenting IVUS(−) group).

Results: The pre-stenting IVUS(+) group had a larger angiographic minimal lumen diameter and IVUS-derived minimal stent area (MSA) than did the pre-stenting IVUS(−) group. After adjusting, these findings were consistent. The one-year composite of cardiac death, myocardial infarction, and target vessel revascularisation did not differ between the groups. In subgroup analysis, the pre-IVUS(+) group was significantly favoured over the pre-IVUS(−) group in the subset of patients with acute myocardial infarction and lesions with small vessels in terms of larger MSA, and in the subset of patients with chronic total occlusions in terms of better clinical outcomes.

Conclusions: Pre-stenting IVUS assessment prior to DES placement was associated with better acute procedural outcomes, though this did not translate into one-year clinical outcomes in the context of post-stenting IVUS assessment.

Visual summary. Acute and one-year outcomes of pre-stenting intravascular ultrasound: a meta-analysis of randomised clinical trials.