Study designs of evaluations included in the review
Diagnostic applications of IVUS: studies with a sample size of at least 10 were eligible for inclusion. The reported studies included both in vivo and in vitro assessments.
Therapeutic applications of IVUS: randomised controlled trials (RCTs) were eligible for inclusion.
Specific interventions included in the review
Diagnostic applications of IVUS: studies considering IVUS were eligible for inclusion.
Therapeutic applications of IVUS: studies comparing IVUS-guided coronary interventions (percutaneous transluminal coronary angioplasty, stenting, atherectomy or coronary artery bypass graft) with non-IVUS-guided interventions were eligible for inclusion. The included studies examined angioplasty and stenting; adjunctive medication included aspirin, ticlopidine and heparin in various dosages.
Reference standard test against which the new test was compared
Studies comparing IVUS with a histopathological confirmation of extent of disease, measures of functional severity of lesions, or clinical outcomes of patients were eligible for inclusion. Angiography was not considered an appropriate reference standard. Papers using IVUS as the reference standard for the evaluation of other techniques were excluded. The identified studies used histopathology, Duplex scanning, angioscopy, stress myocardial single-photon emission computed tomography, fractional flow reserve, coronary flow reserve, pressure gradient or no reference standard.
Participants included in the review
Diagnostic applications of IVUS: studies investigating patients with vascular damage as well as arterial specimens were included; both peripheral and coronary vessels were analysed.
Therapeutic applications of IVUS: studies of patients undergoing coronary interventions (percutaneous transluminal coronary angioplasty, stenting, atherectomy or coronary artery bypass graft) were eligible for inclusion. The included studies considered patients undergoing angioplasty and stenting.
Outcomes assessed in the review
No inclusion criteria relating to the outcomes were reported in the review.
For diagnostic applications of IVUS, the included studies reported diagnostic accuracy in terms of the sensitivity, specificity and predictive values for the following: extent and type of lesion; the prediction of plaque rupture or dissections; the detection of thrombus; the prediction of the functional significance of a lesion; and the prediction of outcome. Changes in patient management and outcomes were also reported in the included diagnostic studies.
For therapeutic applications of IVUS, the authors reported on the following outcomes: survival, major adverse cardiac events, target lesion/vessel revascularisation, restenosis rate and mean minimal lumen diameter.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.