Intravascular Ultrasound-Guidance Is Associated With Lower Cardiovascular Mortality and Myocardial Infarction for Drug-Eluting Stent Implantation ― Insights From an Updated Meta-Analysis of Randomized Trials ―

BACKGROUND: Randomized trials have been underpowered to determine an effect of intravascular ultrasound (IVUS) guidance on hard outcomes for drug-eluting stent (DES) implantation. METHODS AND RESULTS: Randomized trials that compared IVUS guidance vs. angiographic guidance for DES implantation were included; 10 trials with 5,060 patients. IVUS guidance was associated with a lower incidence of cardiovascular death (odds ratio [OR] 0.44, 95% CI 0.26-0.75), and myocardial infarction (OR 0.55, 95% CI 0.32-0.94). CONCLUSIONS: IVUS-guidance is associated with a lower incidence of cardiovascular death and myocardial infarction in the era of DES. These findings should encourage operators to use IVUS more often.