From the Department of Medicine, University of Florida, Gainesville (I.Y.E., A.N.M., A.Y.E., A.A.B.); and North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
From the Department of Medicine, University of Florida, Gainesville (I.Y.E., A.N.M., A.Y.E., A.A.B.); and North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.)
Circ Cardiovasc Interv. 2016 Apr;9(4):e003700. doi: 10.1161/CIRCINTERVENTIONS.116.003700. Epub 2016 Mar 15.
In the era of drug-eluting stents, it is unknown if intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention should be routinely endorsed. This study aimed to determine if IVUS-guided stent implantation is associated with improved outcomes.
Randomized trials that reported clinical outcomes and compared routine IVUS-guided stent implantation with an angiography-guided approach in the era of drug-eluting stents were included. Summary estimates were constructed primarily using the Peto model. Seven trials with 3192 patients were analyzed. The mean length of the coronary lesions was 32 mm. At a mean of 15 months, routine IVUS-guided percutaneous coronary intervention was associated with a reduction in the risk of major adverse cardiac events (6.5% versus 10.3%; odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly because of reduction in the risk of ischemia-driven target lesion revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5% versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00; P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95% confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the IVUS-guided group.
In the era of drug-eluting stents for diffuse coronary lesions, IVUS-guided percutaneous coronary intervention is superior to angiography-guided percutaneous coronary intervention in reducing the risk of major adverse cardiac events. This is primarily because of reduction in the risk of ischemia-driven target lesion revascularization. This analysis also suggests that risk of cardiovascular mortality and stent thrombosis might be lower with an IVUS-guided approach.
在药物洗脱支架时代，血管内超声（IVUS）指导经皮冠状动脉介入治疗是否应常规推荐尚不清楚。本研究旨在确定 IVUS 指导支架置入术是否与改善结果相关。
纳入了报告临床结局并比较了药物洗脱支架时代常规 IVUS 指导支架置入术与血管造影指导方法的随机试验。主要使用 Peto 模型构建汇总估计值。分析了 7 项纳入 3192 例患者的试验。冠状动脉病变的平均长度为 32mm。在平均 15 个月时，常规 IVUS 指导经皮冠状动脉介入治疗与主要不良心脏事件风险降低相关（6.5%与 10.3%；比值比，0.60；95%置信区间，0.46-0.77；P<0.0001），主要是因为缺血驱动的靶病变血运重建风险降低（4.1%与 6.6%；比值比，0.60；95%置信区间，0.43-0.84；P=0.003）。心血管死亡率（0.5%与 1.2%；比值比，0.46；95%置信区间，0.21-1.00；P=0.05）和支架血栓形成（0.6%与 1.3%；比值比，0.49；95%置信区间，0.24-0.99；P=0.04）的风险似乎也较低。
在弥漫性冠状动脉病变的药物洗脱支架时代，IVUS 指导经皮冠状动脉介入治疗优于血管造影指导经皮冠状动脉介入治疗，可降低主要不良心脏事件的风险。这主要是因为缺血驱动的靶病变血运重建风险降低。该分析还表明，IVUS 指导方法的心血管死亡率和支架血栓形成风险可能较低。
