Zhong Zhaoshuang, Zhao Long, Chen Kaiming, Xia Shuyue
Department of Respiratory, Central Hospital, Shenyang Medical College, Shenyang, China.
Department of Cardiovascular Disease, Central Hospital, Shenyang Medical College, Shenyang, China.
Cardiol Res Pract. 2022 Mar 17;2022:4170060. doi: 10.1155/2022/4170060. eCollection 2022.
The clinical effects of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) lesions remain unclear.
We identified all full-text published studies that compared the effects of IVUS-guided CTO-PCI with angiography-guided CTO-PCI by searching electric databases including PubMed, Embase, Cochrane Library, and ISI Web of Science from the establishment to Nov 2021. There was no language limitation. The endpoints included the incidence of major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR).
Five studies involving a total of 2320 patients were included in this meta-analysis. Compared to the angiography-guided group, IVUS-guided PCI showed no significant reduction in the incidence of MACE ( = 27.4%, = 0.239; RR 0.929, 95% CI 0.765 to 1.128, = 0.457), cardiac death ( = 0.0%, = 0.459; RR 0.574, 95% CI 0.299 to 1.103, = 0.096), all-cause death ( = 0.0%, = 0.964; RR 0.677, 95% CI 0.395 to 1.163, = 0.158), MI ( = 46.7%, = 0.131; RR0.836, 95% CI 0.508 to 1.377, = 0.482), and TVR ( = 21.2%, = 0.279; RR 0.929, 95% CI 0.679 to 1.272, = 0.648).
IVUS-guided PCI demonstrated no significant benefit on MACE, cardiac death, all-cause death, MI, and TVR in patients with CTO lesions. However, given the study's limitations, additional high-quality RCTs are needed.
血管内超声（IVUS）引导下经皮冠状动脉介入治疗（PCI）对慢性完全闭塞（CTO）病变患者的临床效果尚不清楚。
通过检索包括PubMed、Embase、Cochrane图书馆和ISI科学网在内的电子数据库，从建库至2021年11月，我们确定了所有比较IVUS引导下CTO-PCI与血管造影引导下CTO-PCI效果的全文发表研究。无语言限制。终点包括主要不良心脏事件（MACE）、心源性死亡、全因死亡、心肌梗死（MI）和靶血管血运重建（TVR）的发生率。
本荟萃分析纳入了5项研究，共2320例患者。与血管造影引导组相比，IVUS引导下PCI在MACE发生率（ = 27.4%， = 0.239；RR 0.929，95%CI 0.765至1.128， = 0.457）、心源性死亡（ = 0.0%， = 0.459；RR 0.574，95%CI 0.299至1.103， = 0.096）、全因死亡（ = 0.0%， = 0.964；RR 0.677，95%CI 0.395至1.163， = 0.158）、MI（ = 46.7%， = 0.131；RR0.836，95%CI 0.508至1.377， = 0.482）和TVR（ = 21.2%， = 0.279；RR 0.929，95%CI 0.679至1.272， = 0.648）方面均未显示出显著降低。
IVUS引导下PCI对CTO病变患者的MACE、心源性死亡、全因死亡MI和TVR未显示出显著益处。然而，鉴于本研究的局限性，需要更多高质量的随机对照试验。
