Cardialysis, Rotterdam, the Netherlands.
Cork University Hospital, Cork, Ireland.
Cardiovasc Revasc Med. 2024 Feb;59:99-108. doi: 10.1016/j.carrev.2023.08.006. Epub 2023 Aug 26.
Significant unprotected left main coronary artery (ULMCA) disease is encountered in approximately 5 % of patients undergoing diagnostic coronary angiography. Intravascular ultrasound (IVUS) overcomes many of the known limitations of angiography and improves outcomes of patients undergoing percutaneous coronary interventions (PCI) in stable or complex coronary artery disease. The aim of this systematic review is to evaluate the evidence on IVUS-guidance versus angiography-guidance in ULMCA PCI, highlighting the chronological frequencies of event rates in line with the maturation of PCI technique and devices over time.
A comprehensive systematic search in Medline was performed to identify all studies that had assessed the effect of IVUS-guided versus angiography-guided ULMCA PCI on various primary and secondary endpoints.
Seventeen studies (2 randomized, 10 non-randomized and 5 meta-analyses) were included in this systematic review.
This systematic review on IVUS-guided versus angiography-guided PCI in patients with significant ULMCA disease strongly supports the hypothesis that IVUS-guided PCI is associated with a significant reduction in major adverse cardiac events composites, all-cause death, cardiac death, myocardial infarction and stent thrombosis. Ongoing, adequately powered trials will contribute significantly to the level of evidence.
在接受诊断性冠状动脉造影的患者中，约有 5%存在明显的无保护左主干冠状动脉（ULMCA）疾病。血管内超声（IVUS）克服了血管造影的许多已知局限性，并改善了稳定或复杂冠状动脉疾病患者经皮冠状动脉介入治疗（PCI）的预后。本系统评价的目的是评估在 ULMCA PCI 中 IVUS 指导与血管造影指导的证据，重点是随着时间的推移，随着 PCI 技术和器械的成熟，事件发生率的时间顺序频率。
在 Medline 上进行了全面的系统检索，以确定所有评估 IVUS 指导与血管造影指导 ULMCA PCI 对各种主要和次要终点影响的研究。
本系统评价共纳入 17 项研究（2 项随机、10 项非随机和 5 项荟萃分析）。
本系统评价表明，在患有明显 ULMCA 疾病的患者中，IVUS 指导的 PCI 与主要不良心脏事件综合指标、全因死亡、心脏死亡、心肌梗死和支架血栓形成的显著减少密切相关。正在进行的、充分有力的试验将对证据水平做出重大贡献。
