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Acute and One-year Clinical Outcomes of Pre-stenting Intravascular Ultrasound: A Patient-level Meta-analysis of Randomised Clinical Trials.

AIMS
To investigate the association of pre-stenting intravascular ultrasound (IVUS) evaluation on procedural and clinical outcomes for diffuse lesions treated with drug-eluting stent (DES).


METHODS AND RESULTS
In four randomised trials comparing IVUS- and angiography-guided DES placement, a total of 1396 patients who underwent DES implantation with IVUS guidance were identified. Pre-stenting IVUS assessment were 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). 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 groups. On the subgroup analyses, pre-IVUS(+) group was significantly favoured over pre-IVUS(-) group in the subset of acute myocardial infarction and the lesions with small vessels as for the larger MSA, and in the subset of chronic total occlusions as for the better clinical outcomes.


CONCLUSIONS
Pre-stenting IVUS assessment prior to DES placement was associated with better acute procedural outcomes, though it was not translated to 1-year clinical outcomes in the context of post-stenting IVUS assessment.