Hu Mengjin, Tan Jiangshan, Yang Yuejin
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
J Cardiovasc Dev Dis. 2022 Oct 8;9(10):343. doi: 10.3390/jcdd9100343.
New randomized trials and modalities in guiding percutaneous coronary intervention (PCI) have become available.
We aimed to compare the clinical outcomes of coronary angiography (CAG), intravascular ultrasound (IVUS), optical coherence tomography (OCT), fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and optical frequency domain imaging (OFDI)-guided PCI.
A network meta-analysis was performed to compare different PCI guidance modalities. The clinical outcomes included major adverse cardiovascular events (MACE), all-cause death, myocardial infarction (MI), and target vessel/lesion revascularization (TVR/TLR). Odds ratio (OR) and corresponding 95% credible interval (CrI) were calculated.
Thirty-six randomized trials, including 19,042 patients, were included. In comparison with CAG, IVUS significantly reduced MACE (OR: 0.71; 95% CrI: 0.57 to 0.86) and TVR/TLR (OR: 0.53; 95% CrI: 0.43 to 0.66). MACE (OR: 1.44; 95% CrI: 1.02 to 2.08) and TVR/TLR (OR: 1.87; 95% CrI: 1.04 to 3.71) were significantly increased in the FFR group, compared with IVUS group. There were no significant differences in MACE or TVR/TLR among the left guidance modality comparisons. Differences in all-cause death or MI were not observed in any comparisons.
IVUS could reduce MACE and TVR/TLR, compared with CAG or FFR. Therefore, IVUS may be the optimal modality in guiding PCI.
在指导经皮冠状动脉介入治疗（PCI）方面，新的随机试验和方法已经出现。
我们旨在比较冠状动脉造影（CAG）、血管内超声（IVUS）、光学相干断层扫描（OCT）、血流储备分数（FFR）、瞬时无波比率（iFR）以及光学频域成像（OFDI）指导下的PCI的临床结局。
进行一项网状Meta分析以比较不同的PCI指导方式。临床结局包括主要不良心血管事件（MACE）、全因死亡、心肌梗死（MI）以及靶血管/病变血管重建术（TVR/TLR）。计算优势比（OR）及相应的95%可信区间（CrI）。
纳入36项随机试验，共19042例患者。与CAG相比，IVUS显著降低了MACE（OR：0.71；95%CrI：0.57至0.86）和TVR/TLR（OR：0.53；95%CrI：0.43至0.66）。与IVUS组相比，FFR组的MACE（OR：1.44；95%CrI：1.02至2.08）和TVR/TLR（OR：1.87；95%CrI：1.04至3.71）显著增加。在左主干指导方式比较中，MACE或TVR/TLR无显著差异。在任何比较中均未观察到全因死亡或MI的差异。
与CAG或FFR相比，IVUS可降低MACE和TVR/TLR。因此，IVUS可能是指导PCI的最佳方式。
