Casella Gianni, Klauss Volker, Ottani Filippo, Siebert Uwe, Sangiorgio Pietro, Bracchetti Daniele
Catheterization Laboratory, Ospedale Maggiore, Bologna, Italy.
Catheter Cardiovasc Interv. 2003 Jul;59(3):314-21. doi: 10.1002/ccd.10537.
To date, only a few studies have compared the clinical efficacy of intracoronary ultrasound (IVUS)-guided to angiographically guided stenting. Furthermore, it is not yet known whether the lower restenosis rate shown with the former strategy would translate into a substantial clinical advantage. Therefore, the aim of the present investigation was to improve the level of evidence of these studies by means of a formal meta-analysis. Nine studies were considered suitable for analysis. Odds ratios (ORs) were calculated for 6-month clinical follow-up. Primary endpoint was a composite of death and nonfatal myocardial infarction (MI), as considered in every single study. Secondary endpoints were major adverse cardiac events (MACEs), according to single study definition, the individual cardiac events, as well as several pre- and postprocedure and follow-up angiographic parameters. Overall, 2,972 patients were included. At 6 months, the OR for death and nonfatal MI was 1.13 (95% CI = 0.79-1.61; P = 0.5) for patients with IVUS-guided stenting. However, patients with IVUS-guided stenting had less target vessel revascularizations (OR = 0.62; 95% CI = 0.49-0.78; P = 0.00003) and MACEs (OR = 0.79; 95% CI = 0.64-0.98; P = 0.03) compared to angiographically guided stenting. In addition, subjects treated with IVUS-guided stenting had significantly less binary restenosis (OR = 0.75; 95% CI = 0.60-0.94; P = 0.01). The present meta-analysis demonstrates that IVUS-guided stenting implantation has a neutral effect on long-term death and nonfatal MI compared to an angiographic optimization. However, IVUS-guided stenting significantly lowers 6-month angiographic restenosis and target vessel revascularizations. Whether these benefits could be very helpful when dealing with lesions at high risk for restenosis is still an issue.
迄今为止，仅有少数研究比较了冠状动脉内超声（IVUS）引导下支架置入术与血管造影引导下支架置入术的临床疗效。此外，尚不清楚前一种策略所显示的较低再狭窄率是否会转化为实质性的临床优势。因此，本研究的目的是通过正式的荟萃分析提高这些研究的证据水平。九项研究被认为适合进行分析。计算了6个月临床随访的比值比（OR）。主要终点是每项研究中所考虑的死亡和非致命性心肌梗死（MI）的复合终点。次要终点是根据单项研究定义的主要不良心脏事件（MACE）、个体心脏事件以及几个术前、术后和随访血管造影参数。总体而言，共纳入2972例患者。在6个月时，IVUS引导下支架置入术患者死亡和非致命性MI的OR为1.13（95%CI = 0.79 - 1.61；P = 0.5）。然而，与血管造影引导下支架置入术相比，IVUS引导下支架置入术患者的靶血管再血管化较少（OR = 0.62；95%CI = 0.49 - 0.78；P = 0.00003），MACE也较少（OR = 0.79；95%CI = 0.64 - 0.98；P = 0.03）。此外，接受IVUS引导下支架置入术治疗的患者二元再狭窄明显较少（OR = 0.75；95%CI = 0.60 - 0.94；P = 0.01）。本荟萃分析表明，与血管造影优化相比，IVUS引导下支架置入术对长期死亡和非致命性MI具有中性作用。然而，IVUS引导下支架置入术可显著降低6个月时的血管造影再狭窄和靶血管再血管化。在处理再狭窄高危病变时，这些益处是否非常有用仍是一个问题。
