Comparison of clinical outcomes between intravascular ultrasound-guided and angiography-guided drug-eluting stent implantation: A meta-analysis of randomised control trials and systematic review.

This systematic review was designed to evaluate the overall efficacy of angiography-guided drug-eluting stent (DES) implantation vs intravascular ultrasound-guided (IVUS) implantation for percutaneous coronary intervention. The electronic databases CENTRAL, PubMed, Cochrane, and EMBASE were searched for systematic reviews to investigate angiography-guided and IVUS-guided DES implantation. We measured the following six parameters in each patient: cardiovascular death, stent thrombosis, target lesion revascularisation (TLR), myocardial infarction (MI), major adverse cardiac events (MACEs), and all-cause death. Twelve studies involving 6268 subjects were included, with 2984 receiving IVUS-guided DES implantation and 3284 using angiography-guided DES implantation. With regard to MACEs, TLR, MI, cardiovascular death, and all-cause death, the IVUS-guided DES implantation group had remarkably improved clinical outcomes. However, there was no significant statistical difference in stent thrombosis between the two groups. Dramatic decrease in MACEs through IVUS guidance was presented by trial sequential analysis. Remarkably improved clinical outcomes, including MACEs, cardiovascular death, all-cause death, and TLR, were identified through IVUS-guided DES implantation in comparison with angiography-guided DES implantation. Nonetheless, the effect on stent thrombosis and MI required further confirmation. In this meta-analysis, eligible randomised clinical trials were warranted to verify the findings and to determine the beneficial effect of IVUS guidance for patients.

Endothelial nitric oxide synthase gene polymorphisms and risk of erectile dysfunction: An updated meta-analysis of genetic association studies.

PURPOSE: Endothelial nitric oxide synthase (eNOS) polymorphisms have been implicated as risk factors for erectile dysfunction (ED), but the results of genetic association studies are inconclusive. We performed a meta-analysis of published studies investigating the association between ED and three eNOS polymorphisms, intron 4 VNTR, G894T and T786C in humans. METHODS: The PubMed, Web of Science, CNKI and Google Scholar databases were searched for relevant studies published up to November 2017. Association studies with case-control design were included. For each study with genotype information we calculated odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The search identified 13 eligible studies. The G894T and T786C polymorphisms showed a significant association with ED risk in Caucasians (GT + TT versus GG for G894T: OR = 2.13, 95% CI = 1.08-4.19; CC versus CT + TT for T786C: OR = 3.29, 95% CI = 2.30-4.72) and Asians (GT + TT versus GG for G894T: OR = 2.08, 95% CI = 1.53-2.84; CC + CT versus TT for T786C: OR = 3.13, 95% CI = 1.35-7.25). In addition, the intron 4 VNTR polymorphism was associated with ED risk only among Caucasian subjects (aa versus bb + ab: OR = 2.38, 95% CI = 1.15-4.93). We found no evidence of publication bias. The robustness of overall analyses was ensured in sensitivity analyses excluding studies deviating from Hardy-Weinberg equilibrium. CONCLUSION: Our findings suggest that common genetic polymorphisms in the eNOS gene contribute to risk of ED, presumably by effects on eNOS activity and NO availability.