Steinvil Arie, Zhang Yao-Jun, Lee Sang Yeub, Pang Si, Waksman Ron, Chen Shao-Liang, Garcia-Garcia Hector M
Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA.
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Int J Cardiol. 2016 Aug 1;216:133-9. doi: 10.1016/j.ijcard.2016.04.154. Epub 2016 Apr 23.
The use of intravascular ultrasound (IVUS) guidance for drug-eluting stent (DES) optimization is limited by the number of adequately powered randomized control trials (RCTs). We performed an updated meta-analysis, including data from recently published RCTs and observational studies, by reviewing the literature in Medline and the Cochrane Library to identify studies that compared clinical outcomes between IVUS-guided and angiography-guided DES implantation from January 1995 to January 2016. This meta-analysis included 25 eligible studies, including 31,283 patients, of whom 3192 patients were enrolled in 7 RCTs. In an analysis of all 25 studies, the summary results for all the events analyzed were significantly in favor of IVUS-guided DES implantation [major adverse cardiac events (MACE, odds ratio [OR] 0.76, 95% confidence intervals [CI]: 0.70-0.82, P<0.001); death (OR 0.62, 95% CI: 0.54-0.72, P<0.001); myocardial infarction (OR 0.67, 95% CI: 0.56-0.80, P<0.001); stent thrombosis (OR 0.58, 95% CI: 0.47-0.73, P<0.001); target lesion revascularization (TLR, OR 0.77, 95% CI: 0.67-0.89, P=0.005); target vessel revascularization (TVR, OR 0.85, 95% CI: 0.76-0.95, P<0.001)]. However, in a separate analysis of RCTs, a favorable result for IVUS-guided DES implantation was found only for MACE (OR 0.66, 95% CI: 0.52-0.84, P=0.001), TLR (OR 0.61, 95% CI: 0.43-0.87, P=0.006), and TVR (OR 0.61, 95% CI: 0.41-0.90, P=0.013). IVUS-guided percutaneous coronary intervention was associated with better overall clinical outcomes than angiography-guided DES implantation. However, in a solely RCT meta-analysis, this benefit was mainly driven by reduced rates of revascularizations.
血管内超声（IVUS）引导用于优化药物洗脱支架（DES）受到充分有力的随机对照试验（RCT）数量的限制。我们进行了一项更新的荟萃分析，通过检索Medline和Cochrane图书馆中的文献，纳入最近发表的RCT和观察性研究的数据，以确定1995年1月至2016年1月期间比较IVUS引导与血管造影引导下DES植入临床结局的研究。该荟萃分析纳入了25项符合条件的研究，共31283例患者，其中3192例患者纳入了7项RCT。在对所有25项研究的分析中，所有分析事件的汇总结果均显著支持IVUS引导下的DES植入[主要不良心脏事件（MACE，优势比[OR]0.76，95%置信区间[CI]：0.70 - 0.82，P<0.001）；死亡（OR 0.62，95% CI：0.54 - 0.72，P<0.001）；心肌梗死（OR 0.67，95% CI：0.56 - 0.80, P<0.001）；支架血栓形成（OR 0.58，95% CI：0.47 - 0.73，P<0.001）；靶病变血运重建（TLR，OR 0.77，95% CI：0.67 - 0.89，P = 0.005）；靶血管血运重建（TVR，OR 0.85，95% CI：0.76 - 0.95，P<0.001）]。然而，在对RCT的单独分析中，仅在MACE（OR 0.66，95% CI：0.52 - 0.84，P = 0.001）、TLR（OR 0.61，95% CI：0.43 - 0.87，P = 0.006）和TVR（OR 0.61，95% CI：0.41 - 0.90，P = 0.013）方面发现IVUS引导下DES植入有良好结果。IVUS引导的经皮冠状动脉介入治疗与血管造影引导的DES植入相比，总体临床结局更好。然而，在仅RCT的荟萃分析中，这种益处主要由血运重建率降低所驱动。
