Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA.
Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Int J Cardiovasc Imaging. 2024 Aug;40(8):1653-1659. doi: 10.1007/s10554-024-03150-7. Epub 2024 Jun 14.
Although multiple randomized clinical trials (RCTs) have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography-guided PCI, its benefits specifically in calcified coronary lesions is unclear due to the small number of patients included in individual trials. We performed a meta-analysis of RCTs to investigate benefits of IVI-guided PCI compared with angiography-guided PCI in heavily calcified coronary lesions. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, target-vessel or target-lesion myocardial infarction, and target-vessel or target lesion revascularization. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated by using a random-effects meta-analysis based on the restricted maximum likelihood method. A search PubMed, EMBASE, and Cochrane Library from their inception to January 2024 identified 4 trials that randomized 1319 patients with angiographically moderate or severe or severe coronary calcification to IVI-guided (n = 702) vs. angiography-guided PCI (n = 617). IVI-guided PCI resulted in a significantly lower odds of MACE (OR 0.57, 95% CI 0.40-0.80) compared with angiography-guided PCI at a weighted median follow-up duration of 27.3 months. There was no evidence of heterogeneity among the studies (I = 0.0%), and included trials were judged to be low risk of bias. Compared with angiography-guided PCI, IVI-guided PCI was associated with a significantly lower MACE in angiographically heavily calcified coronary lesions.
尽管多项随机临床试验 (RCT) 表明，血管内成像 (IVI) 指导的经皮冠状动脉介入治疗 (PCI) 与血管造影指导的 PCI 相比，具有改善临床结局的优势，但由于各试验纳入的患者数量较少，其在严重钙化性冠状动脉病变中的益处尚不清楚。我们对 RCT 进行了荟萃分析，以研究 IVI 指导的 PCI 与血管造影指导的 PCI 在严重钙化性冠状动脉病变中的益处。主要终点是主要不良心脏事件 (MACE)，是心脏死亡、靶血管或靶病变心肌梗死以及靶血管或靶病变血运重建的复合终点。采用基于限制性极大似然法的随机效应荟萃分析计算汇总优势比 (OR) 和 95%置信区间 (CI)。从创建到 2024 年 1 月，通过 PubMed、EMBASE 和 Cochrane Library 进行检索，确定了 4 项将 1319 例血管造影中度或重度或重度冠状动脉钙化的患者随机分为 IVI 指导组 (n = 702) 和血管造影指导 PCI 组 (n = 617) 的 RCT。IVI 指导 PCI 组与血管造影指导 PCI 组相比，MACE 的发生风险显著降低 (OR 0.57，95% CI 0.40-0.80)，加权中位数随访时间为 27.3 个月。各研究之间无异质性 (I = 0.0%)，纳入的研究被判定为低偏倚风险。与血管造影指导 PCI 相比，IVI 指导 PCI 与严重钙化性冠状动脉病变的 MACE 发生率显著降低相关。
