药物洗脱支架时代血流动力学参数或血管内成像引导的经皮冠状动脉介入治疗后的临床结局：28项随机试验和11860例患者的最新系统评价和贝叶斯网络荟萃分析

Clinical Outcomes Following Hemodynamic Parameter or Intravascular Imaging-Guided Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents: An Updated Systematic Review and Bayesian Network Meta-Analysis of 28 Randomized Trials and 11,860 Patients.

作者信息

Hu Meng-Jin, Tan Jiang-Shan, Yin Lu, Zhao Yan-Yan, Gao Xiao-Jin, Yang Jin-Gang, Yang Yue-Jin

机构信息

State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Front Cardiovasc Med. 2022 Jun 3;9:860189. doi: 10.3389/fcvm.2022.860189. eCollection 2022.

BACKGROUND

Coronary angiography (CAG) is the standard imaging modality for guiding percutaneous coronary interventions (PCI). Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and hemodynamic parameter like fractional flow reserve (FFR) can overcome some limitations of CAG.

OBJECTIVE

We sought to explore the clinical outcomes of different PCI guidance modalities in the era of drug-eluting stent (DES).

METHODS

A network meta-analysis of 28 randomized trials and 11,860 patients undergoing different modalities-guided PCI in the era of DES was performed. Odds ratio (OR) with 95% credible interval (CrI) were calculated.

RESULTS

In comparison with CAG, IVUS was associated with a significant reduction in major adverse cardiovascular events (MACE, : 0.60; 95% : 0.46-0.79), cardiovascular death (: 0.46; 95% : 0.20-0.94), target vessel/lesion revascularization (TVR/TLR, : 0.55; 95% : 0.41-0.74), and a trend toward decreased risk of stent thrombosis (: 0.44; 95% : 0.17 to 1.00). FFR/quantitative flow ratio (QFR) could significantly reduce stroke compared with CAG, IVUS, and OCT/optical frequency domain imaging (OFDI). However, myocardial infarction (MI), all-cause death, stent thrombosis, and any revascularization presented similar risks for different PCI guidance modalities.

CONCLUSION

In the era of DES, IVUS led to lower risks of MACE than CAG, which was mainly due to lower risks of cardiovascular death and TVR/TLR. A trend toward decreased risk of stent thrombosis was also observed with IVUS. Hemodynamic parameter (FFR/QFR)-guided PCI could significantly reduce the stroke risk compared with CAG, IVUS, and OCT/OFDI.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021291442].

背景

冠状动脉造影（CAG）是指导经皮冠状动脉介入治疗（PCI）的标准成像方式。血管内超声（IVUS）和光学相干断层扫描（OCT）等冠状动脉内成像技术以及血流储备分数（FFR）等血流动力学参数可以克服CAG的一些局限性。

目的

我们试图探讨药物洗脱支架（DES）时代不同PCI指导方式的临床结局。

方法

对28项随机试验和11860例在DES时代接受不同方式指导的PCI患者进行网络荟萃分析。计算95%可信区间（CrI）的比值比（OR）。

结果

与CAG相比，IVUS与主要不良心血管事件（MACE，OR：0.60；95%CrI：0.46 - 0.79）、心血管死亡（OR：0.46；95%CrI：0.20 - 0.94）、靶血管/病变血运重建（TVR/TLR，OR：0.55；95%CrI：0.41 - 0.74）显著降低相关，并且支架血栓形成风险有降低趋势（OR：0.44；95%CrI：0.17至1.00）。与CAG相比，FFR/定量血流比（QFR）可显著降低卒中风险，与IVUS和OCT/光学频域成像（OFDI）相比也是如此。然而，心肌梗死（MI）、全因死亡、支架血栓形成和任何血运重建在不同PCI指导方式下呈现相似风险。