Geographic heterogeneity in outcomes of intravascular ultrasound-guided vs angiography-guided percutaneous coronary intervention: a meta-analysis of randomized trials
Authors' conclusion
Considering all studies, IVUS-guided PCI reduced cardiac death, TV-MI, TVR, MACE, and stent thrombosis. However, significant interactions were present such that the relative reductions in cardiac death, TV-MI, TVR, and MACE were greater in the Asian compared with non-Asian trials (although stent thrombosis was reduced consistently across geographies).
Study context
- Population
- Patients undergoing drug-eluting stent percutaneous coronary intervention (PCI) in randomised trials, East Asian and non-Asian
- Participants
- 14,033 patients · 17 trials
- Comparison
- Intravascular ultrasound (IVUS)-guided vs angiography-guided drug-eluting stent PCI
- Outcome
- Interaction test for cardiac death by geography (East Asian vs non-Asian)
Methodological detailsrandom-effects (REML, Hartung-Knapp-Sidik-Jonkman), pre-specified geographic effect modification
- Random-effects (REML, Hartung-Knapp-Sidik-Jonkman)
- Pre-specified geographic effect modification
Pooled result
As reported in the abstract
Pooled RR for cardiac death, all trials
.71 (95% CI .53-.94), P = .022
Pooled RR for cardiac death, East Asian trials
.56
.46-.69
Pooled RR for cardiac death, non-Asian trials
1.23
.85–1.76
Geographic interaction for cardiac death
interaction P < .001
Further pooled results
Target-vessel myocardial infarction (TV-MI), target-vessel revascularization (TVR) and major adverse cardiovascular events (MACE), by geography
- Treatment effects diverged by geography for TV-MI
- interaction P = .011
- Treatment effects diverged by geography for TVR
- interaction P = .004
- Treatment effects diverged by geography for MACE
- interaction P = .040
Definite stent thrombosis
- IVUS guidance reduced definite stent thrombosis: pooled RR
- .39 (95% CI .19-.79)
- Geographic interaction for definite stent thrombosis
- interaction P = .433
All-cause death
- All-cause death similar: pooled RR
- .89 (95% CI .76-1.04)
Original publication
Summarised from the published abstract; every number is checked against it