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Objective  Previous evidence suggested that intravascular ultrasound (IVUS) guidance could improve outcomes after drug-eluting stents (DES) placement, largely driven by data from observational studies. We, therefore, performed a meta-analysis and trial sequential analysis of randomized controlled trials to overcome this limitation.    Results  The retrieval process yielded 7 RCTs with 3,192 patients. Compared to the angiography guidance, IVUS-guided DES implantation was associated with a significant reduction in the major adverse cardiac events (MACE) (OR 0.60, 95% CI 0.46-0.78;  P  < 0.001), target vessel revascularization (OR 0.60, 95% CI 0.40-0.91;  P  = 0.02) and target lesion revascularization (OR 0.60, 95% CI 0.42-0.85;  P  = 0.004). IVUS and conventional angiography guidance showed similar incidence of stent thrombosis (ST) (OR 0.56, 95% CI 0.25-1.23;  P  = 0.15), cardiac death (OR 0.47, 95% CI 0.19-1.15;  P  = 0.10) and myocardial infarction (OR 0.85, 95% CI 0.45-1.61;  P  = 0.62). Trial sequential analysis revealed a definite reduction in MACE with IVUS guidance without solid evidence for ST.    Materials and Methods  A systematical literature search was performed in the databases of PubMed, the Cochrane Library and  ClinicalTrials.gov , complemented with reference screening from relevant articles. Primary endpoints were MACE and ST.    Conclusions  IVUS-guided DES implantation is associated with a lower risk of MACE and revascularization without conclusive benefits for ST.

Intravascular ultrasound guidance in drug-eluting stents implantation: a meta-analysis and trial sequential analysis of randomized controlled trials