血管内超声与血管造影指导的经皮冠状动脉介入治疗的短期和长期预后：一项涉及 24783 例患者的荟萃分析。
Short- and Long-Term Prognosis of Intravascular Ultrasound-Versus Angiography-Guided Percutaneous Coronary Intervention: A Meta-Analysis Involving 24,783 Patients.
机构信息
Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
出版信息
J Interv Cardiol. 2021 Oct 15;2021:6082581. doi: 10.1155/2021/6082581. eCollection 2021.
BACKGROUND
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) has potential benefits. This meta-analysis aimed to explore whether IVUS-guided PCI had better short- and long-term prognoses than angiography-guided PCI.
METHODS
We retrieved studies from PubMed, Embase, and Cochrane Library. Clinical trials including retrospective and randomized controlled trials (RCTs) that compared IVUS-guided PCI with angiography-guided PCI were included. The patients were followed up after operation at 30 days, 1 year, 2 years, and 3 years. The clinical outcomes were target lesion revascularization (TLR), target vessel revascularization (TVR), and MACEs, including stent thrombosis (ST), myocardial infarction (MI), cardiac death, and all-cause death. The study population included patients with MI, coronary bifurcation lesions, short or long lesions, and unprotected left main coronary artery stenosis (ULMCA). The quality of retrospective trials was evaluated using the Newcastle-Ottawa Scale, and the quality of randomized controlled trials was evaluated using the Jadad score. A total of 20 clinical trials met the criteria. Three trials were randomized controlled trials, while 17 were retrospective trials.
RESULTS
A total of 24,783 patients were included. In observational trials, the OR of MACEs was 0.49 (95% CI: 0.38-0.62) in 30 days, 0.65 (95% CI: 0.58-0.73) in one year, 0.51 (95% CI: 0.36-0.71) in two years, and 0.45 (95% CI: 0.31-0.65) in three years. In patients with long coronary lesions, the OR of MACEs in 1 year was 0.64 (95% CI: 0.28-1.50). In patients with left main artery disease, the OR of MACEs in 3 years was 0.42 (95% CI: 0.26-0.67). Compared with angiography-guided PCI, IVUS-guided PCI was associated with a lower incidence of MACEs during the same following period.
CONCLUSION
Compared with angiography-guided PCI, IVUS-guided PCI has better performance in reducing the occurrence of MACEs.
背景
血管内超声（IVUS）指导的经皮冠状动脉介入治疗（PCI）具有潜在的益处。本荟萃分析旨在探讨 IVUS 指导的 PCI 是否比血管造影指导的 PCI 具有更好的短期和长期预后。
方法
我们从 PubMed、Embase 和 Cochrane 图书馆检索了研究。纳入了比较 IVUS 指导的 PCI 与血管造影指导的 PCI 的回顾性和随机对照试验（RCT）的临床试验。患者在手术后 30 天、1 年、2 年和 3 年进行随访。临床结局为靶病变血运重建（TLR）、靶血管血运重建（TVR）和 MACE，包括支架血栓形成（ST）、心肌梗死（MI）、心脏死亡和全因死亡。研究人群包括 MI、冠状动脉分叉病变、短或长病变以及无保护左主干冠状动脉狭窄（ULMCA）的患者。使用纽卡斯尔-渥太华量表评估回顾性试验的质量，使用 Jadad 评分评估随机对照试验的质量。共有 20 项临床试验符合标准。其中 3 项为随机对照试验，17 项为回顾性试验。
结果
共纳入 24783 名患者。在观察性试验中，30 天时 MACE 的 OR 为 0.49（95%CI：0.38-0.62），1 年时为 0.65（95%CI：0.58-0.73），2 年时为 0.51（95%CI：0.36-0.71），3 年时为 0.45（95%CI：0.31-0.65）。在长冠状动脉病变患者中，1 年时 MACE 的 OR 为 0.64（95%CI：0.28-1.50）。在左主干病变患者中，3 年时 MACE 的 OR 为 0.42（95%CI：0.26-0.67）。与血管造影指导的 PCI 相比，IVUS 指导的 PCI 在同一随访期间发生 MACE 的发生率较低。
结论
与血管造影指导的 PCI 相比，IVUS 指导的 PCI 在降低 MACE 发生率方面表现更好。
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