Objective:To systematically review the clinical outcomes of drug-eluting stents (DES) guided by intravascular ultrasound(IVUS) versus coronary angiography (CAG) for the patients with coronary artery disease (CAD). Methods:We searched relevant literatures in PubMed,Embase,Cochrane Library,Scopus and Chinese Biomedical Database from January in 2000 to July in 2016,meanwhile,collected published data and studies from cardiovascular congresses to compare IVUS- and CAG-guided DES implantation for CAD patients. Meta-analyses were conducted by STATA 12.0 software. Results:Twenty-three eligible studies with a total of 31 685 patients were enrolled,of whom 3 192 patients were from randomized controlled trials. In general,intervention with DES guided by IVUS was associated with significant improvements on death(OR:0.63,95% CI:0.55~0.73,P < 0.001),myocardial infarction(MI,OR:0.69,95%CI:0.58~0.82,P < 0.001),major adverse cardiac events(MACE,OR:0.75,95%CI:0.69~0.82,P < 0.001),stent thrombosis(OR:0.56,95%CI:0.43~0.73,P < 0.001),target vessel revascularization(TVR,OR:0.79,95%CI:0.68~0.93,P < 0.001),and target lesion revascularization(TLR,OR:0.75,95%CI:0.62~0.91,P < 0.001),when compared with CAG guidance. Conclusion:IVUS guidance was associated with significantly improved clinical outcomes,including death,MI,MACE,stent thrombosis and re-intervention,compared with CAG guidance in the treatment of patients with CAD. Appropriately powered randomized trials are warranted to verify the findings of this meta-analysis and determine which types of patients and lesions will be benefit more from IVUS guidance.