We performed a metaanalysis to compare clinical outcomes of ivus. Net framework, and features a graphical user interface. Although the image presentation may vary among companies and although the ivus console and software controls certainly do vary, there is no clinically meaningful difference among. Meta analysis of outcomes after intravascular ultrasoundguided versus angiographyguided drugeluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies.
A meta analysis to evaluate the controversial role of ivus guided pci with baremetal stenting was performed and a previous published meta analysis was reevaluated in order to clarify the discrepancy between results of these. Intravascular ultrasound imagingguided versus coronary angiographyguided percutaneous coronary intervention. Let me know in the comment section below what meta analysis software you are using. We implemented the meta analysis methodology in an microsoft excel addin which is freely available and incorporates more meta analysis models including the iterative maximum likelihood and profile likelihood than are usually available, while paying particular attention to the userfriendliness of the package. Clinical benefit of ivus guidance for coronary stenting jacc. Thats partly because of the manual and tutorial which take you through the analysis step by step.
Meta analysis is increasingly used as a key source of evidence synthesis to inform clinical practice. This site uses cookies to store information on your computer. There are loads of packages in r associated with meta analysis. The cran meta analysis task view is exceptionally wellorganized listing r. Finally, meta regression analysis may be not powered because only 7 clinical trials were included in the present meta analysis. The role of intravascular ultrasound ivus in percutaneous coronary interventions pci is still controversial despite several previously published meta analyses.
Current guidelines recommend intravascular ultrasound ivus guided percutaneous coronary intervention pci in patients with left main coronary artery disease lm cad. Accuracy of intravascular ultrasound and optical coherence. Update on ffr, oct, and ivus cardiac interventions today. We conducted a meta analysis to assess the accuracy of coronary cta against ivus regarding coronary vessel and plaque sizes, as well as the accuracy sensitivity and specificity of ct to detect any plaque compared with ivus. Comparison between mdct and grayscale ivus in a quantitative analysis of coronary lumen in segments with or without atherosclerotic plaques. Outcomes with intravascular ultrasoundguided stent. The objectives of our metaanalysis are to assess the effect of ivus on clinical. Coronary ivus intravascular ultrasound philips healthcare. Use the links below to jump to the meta analysis topic you would like to examine. Typical indications for performing ivus include determining stenosis severity, evaluating extent of vessel calcification, sizing of the vessel, discerning the mechanism of stent failure and characterizing lesion composition. Intravascular ultrasound imagingguided versus coronary angiography guided percutaneous coronary intervention. We performed a meta analysis to compare clinical outcomes of ivus versus conventional angiography guidance during implantation of des for patients with lmca disease.
The purpose of this meta analysis was therefore to investigate the impact of statin therapy on coronary plaque composition. Ivusguided des implantation is associated with a lower. Intravascular ultrasoundguided stent implantation reduces cardiovascular mortality updated metaanalysis of randomized controlled trials. Could anyone suggest a free software for meta analysis. Which statistical software is most useful for meta analysis another than revman. Coronary atherosclerosis imaging by coronary ct angiography. Does intravascular ultrasound provide clinical benefits for. Sep 18, 2015 however, these studies were conducted in relatively small study cohorts and are not conclusive. It should be noted that the eighth study also showed no outcomes benefit to intracoronary physiology. Meta analysis of outcomes after intravascular ultrasoundguided versus. Jun 10, 2016 ivus may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography.
The software performs several metaanalysis and meta regression models for binary and continuous outcomes, as well as analyses for diagnostic and prognostic test studies in the frequentist and bayesian frameworks. Vh ivus analysis was done in those patients showing intimal thickening greater than 0. In practice, most meta analyses are performed in general statistical packages or dedicated meta analysis programs. Intravascular ultrasoundguided stent implantation reduces. I want to know which statistical programs thats simple to use and being able to download for meta analysis. A meta analysis of randomized trials demonstrated that stenting with a baremetal stent guided by ivus, compared with angiography, significantly reduced major adverse cardiac events. Metaanalysis of outcomes after intravascular ultrasoundguided versus. I wish to test the potential association between candidate gene polymorphism and specific disease risk in different populations. Intravascular ultrasound predictors of major adverse. The use of intravascular ultrasound ivus to guide stent placement in percutaneous coronary intervention pci leads to better clinical outcomes than use of angiography guidance, according to a meta analysis published online february 12, 2014, ahead of print in jacc. Virtual histology intravascular ultrasound vh ivus imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Its also extremely versatile in terms of the type of input data it will accept which is really valuable because with a metaanalysis you have to take what data you can get. In this section you can download the metaeasy excel addin, described in the journal of statistical software click here for the paper.
Philips volcano core mobile precision guided therapy system. Sep 18, 2015 virtual histology intravascular ultrasound vh ivus imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. On multivariable cox regression analysis, independent ivus predictors of mace. An analysis of ivusguided pci and angiographyguided pci from an italian healthcare payer perspective found that ivusguided pci with des is a dominant treatment option compared to angiographyguided pci with des. This meta analysis compared ivus guided with angiographyguided pci to determine the effect of ivus on the mortality in patients with lm cad. Interventions of the left main coronary artery are complex and require high degree of technical skills. Percutaneous coronary intervention in left main coronary. Scott parrott, phd, department of interdisciplinary studies, rutgers university. A new metaanalysis shows ivus edge over angiography for guiding stent placement extends to drugeluting stents as well as baremetal stents. Core mobile is designed to power the future of precision guided therapy and offers the choice of imaging and physiology on a single mobile platform core mobile also provides clarity in your approach and confidence in your results by offering additional information during the diagnostic phase, assisting in intervention decisions.
If playback doesnt begin shortly, try restarting your device. Metaanalysis software forest plot radial plot ncss. We, therefore, performed a meta analysis and trial sequential analysis of randomized controlled trials to overcome this limitation. It is not established whether and to what extent statins have an effect on coronary plaque composition. Their impact on timi grade flow and clinical outcomes remains undefined. Measurements of the lumen can be performed manually or with automated software. Evidence for the effects of statin therapy on vh ivus parameters have been inconclusive. Go to part i even though there are many uses of intravascular ultrasound ivus in the catheterization laboratory, the interventional cardiologist has only two fundamental questions and only two basic decisions when performing a percutaneous coronary intervention pci. This metaanalysis compared ivusguided with angiographyguided pci to. We performed this meta analysis to assess the efficacy of use of ivus compared to angiographicguided pci. Impact of statin therapy on coronary plaque composition. Ivusguided pci in the era of drugeluting stents consult qd.
Download clinical evidence and guidelines for the use of ivus in pci, and explore the. Jul 17, 2014 however, r is the natural platform for meta analysis both because of the myriad possibilities for statistical analyses that are not generally available through the specialized software, and because of the many packages devoted to various aspects of meta analysis. Ivus provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images. Which statistical software is most useful for meta. Fifth, the criteria for ivus guidance are distinct across the included studies, which may affect the final results of our meta analysis. Impact of attenuated plaques on timi grade flow and clinical.
Jan 15, 2020 the main finding of this updated comprehensive meta analysis of rcts, evaluating ivus plus angiography versus angiography alone in pci involving des, is a significant reduction in cardiovascular mortality among patients assigned to a strategy of ivus use. Clinical outcomes following intravascular imagingguided. Meta analysis shows benefits of ivus guided pci crtonline. Meta analysis of randomized trials of baremetal stents concluded that ivus guidance was associated with a reduction in major adverse cardiac events mace and repeat revascularization with a neutral effect on death and myocardial infarction but currently percutaneous coronary intervention pci is performed with drugeluting stents. The theory and statistical foundations of meta analysis continually evolve, providing solutions to many new and challenging problems.
To date, no network meta analysis has explored the comparative efficacy of pci guided by different imaging modalities. Ivusguided pci clinical evidence philips healthcare. Aug 29, 2017 previous evidence suggested that intravascular ultrasound ivus guidance could improve outcomes after drugeluting stents des placement, largely driven by data from observational studies. I was able to run a meta analysis in reasonable time.
Ncss includes tools for performing meta analysis of means, proportions, correlated proportions, and hazard ratios. Aug 11, 2016 ivusguided pci in the era of drugeluting stents. Pdf comparison between mdct and grayscale ivus in a. Intravascular ultrasound imagingguided versus coronary. Metaanalysis method there are three different metaanalysis methods available controlled by the method optionmethod 1.
Finally, there are the typical limitations of meta analysis and meta regression, including lack of raw and uniform data, lack of consistent cutpoints threshold are obtained in each study from the results of roc analysis of ivus and octderived anatomical parameters to predict obstructive ffr and that may reduce the level of accuracy, and. However, there is currently no dedicated and comprehensive software for meta analysis of diagnostic data. Ivus in pci guidance american college of cardiology. Percutaneous coronary intervention in left main coronary artery. Metaanalysis shows benefits of ivusguided pci crtonline. We, therefore, performed a metaanalysis and trial sequential analysis. The meta analysis procedures in ncss are easytouse and validated for accuracy.
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