Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Int J Cardiol. 2020 Jan 15;299:100-105. doi: 10.1016/j.ijcard.2019.07.033. Epub 2019 Jul 10.
The use of intravascular ultrasound (IVUS) guidance to facilitate stent implantation has been demonstrated to reduce major adverse cardiovascular events (MACE), predominantly due to a reduction in target lesion revascularization (TLR). The objectives of our meta-analysis are to assess the effect of IVUS on clinical outcomes, including cardiovascular mortality.
RCTs comparing drug-eluting stent (DES) implantation using IVUS plus angiography versus angiography alone were identified from a comprehensive search in PubMed, Embase, and Cochrane library. Pooled relative risks (RR) were obtained using DerSimonian and Laird estimator for the random effects model.
The search yielded 10 RCTs (5007 participants) in which the relevant data were available. Two trials were performed in patients with chronic total occlusion (CTO), whereas other trials included patients that either had stable ischemic heart disease (22-64%) or presented as an acute coronary syndrome (ACS) (36-78%). Routine use of IVUS was effective in reducing TLR (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.44, 0.80; p < 0.01), target vessel revascularization (TVR) (RR 0.59, 95% CI 0.43, 0.81; p < 0.01), and MACE (RR 0.63, 95% CI 0.51, 0.77; p < 0.01). Cardiovascular mortality was also significantly reduced (RR 0.51, 95% CI 0.27, 0.96; p = 0.04).
During DES implantation, the routine use of IVUS in addition to angiography improves clinical outcomes, including cardiovascular mortality. These findings reinforce the need for a broader implementation of IVUS-guidance during PCI. Since a significant proportion of patients studied presented as ACS, future trials should assess the benefit of IVUS-guidance in a more focused presentation setting.
血管内超声（IVUS）指导下支架植入术已被证明可以降低主要不良心血管事件（MACE），主要是由于靶病变血运重建（TLR）减少。本荟萃分析的目的是评估 IVUS 对临床结局的影响，包括心血管死亡率。
从 PubMed、Embase 和 Cochrane 图书馆全面检索比较药物洗脱支架（DES）植入时使用 IVUS 加血管造影与单纯血管造影的 RCT。使用随机效应模型的 DerSimonian 和 Laird 估计值获得汇总相对风险（RR）。
检索得到 10 项 RCT（5007 例患者），其中有相关数据。两项试验在慢性完全闭塞（CTO）患者中进行，而其他试验包括稳定型缺血性心脏病（22-64%）或急性冠脉综合征（ACS）（36-78%）患者。常规使用 IVUS 可有效降低 TLR（风险比（RR）0.59，95%置信区间（CI）0.44，0.80；p<0.01）、靶血管血运重建（TVR）（RR 0.59，95% CI 0.43，0.81；p<0.01）和 MACE（RR 0.63，95% CI 0.51，0.77；p<0.01）。心血管死亡率也显著降低（RR 0.51，95% CI 0.27，0.96；p=0.04）。
在 DES 植入术中，血管造影加 IVUS 常规应用可改善临床结局，包括心血管死亡率。这些发现强化了在 PCI 中更广泛应用 IVUS 指导的必要性。由于研究中相当一部分患者表现为 ACS，未来的试验应评估 IVUS 指导在更集中的表现环境中的获益。
