血管内超声与血管造影引导下药物洗脱支架植入术治疗左主干冠状动脉疾病患者的系统评价和荟萃分析
Intravascular Ultrasound versus Angiography Guided Drug Eluting Stent Implantation in Patients with Left Main Coronary Artery Disease - A Systematic Review and Meta-Analysis.
作者信息
Karim Kevin, Akbar Mohammad Rizki, Pramudyo Miftah, Martha Januar Wibawa
机构信息
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, 40161 Bandung, Indonesia.
出版信息
Rev Cardiovasc Med. 2024 Jan 22;25(1):32. doi: 10.31083/j.rcm2501032. eCollection 2024 Jan.
BACKGROUND
Several technical limitations exist in angiography procedures, including suboptimal visualization of a particular location and angiography only providing information about the contour of the vascular lumen, while intravascular ultrasound (IVUS) provides information regarding wall composition on coronary vascular lesions. With recent trials demonstrating IVUS benefits over standard angiography, our meta-analysis aimedto evaluate and summarize the current evidence on whether IVUS-guided drug-eluting stent (DES) placement resulted in better outcomes than the angiography-guided DES placement in patients with left main coronary artery (LMCA) disease. This meta-analysis aimed to analyze the current evidence on the IVUS-guided and angiography-guided drug-eluting stent (DES) placement in patients with LMCA disease.
METHODS
Literature searching was performed using Scopus, Embase, PubMed, EuropePMC, and Clinicaltrials.gov using PRISMA guidelines. The intervention group in our study are patients undergoing IVUS-guided percutaneous coronary intervention (PCI) and the control group are patients undergoing angiography alone-guided PCI. Cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis were compared between the two groups.
RESULTS
There were 11 studies comprising 24,103 patients included in this meta-analysis. IVUS-guided PCI was associated with lower cardiovascular mortality (hazard ratio (HR) 0.39 [95% CI 0.26, 0.58], 0.001; : 75%, 0.001) and all-cause mortality (HR 0.59 [95% CI 0.53, 0.66], 0.001; : 0%, = 0.45) compared to angiography alone guided PCI. The group receiving IVUS guided PCI has a lower incidence of myocardial infarction (HR 0.66 [95% CI 0.48, 0.90], = 0.008; : 0%, = 0.98), target lesion revascularization (HR 0.45 [95% CI 0.38, 0.54], 0.001; : 41%, = 0.10) and stent thrombosis (HR 0.38 [95% CI 0.26, 0.57], 0.001; : 0%, = 0.50) compared to the control group.
CONCLUSIONS
Our meta-analysis demonstrated that IVUS-guided DES placement had lower cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis than angiography-guided DES implantation.
背景
血管造影术存在一些技术局限性，包括特定部位的可视化效果欠佳，且血管造影仅能提供血管腔轮廓的信息，而血管内超声（IVUS）可提供有关冠状动脉病变管壁成分的信息。近期试验表明IVUS优于标准血管造影，我们的荟萃分析旨在评估和总结当前证据，以确定在左主干冠状动脉（LMCA）疾病患者中，IVUS引导下药物洗脱支架（DES）置入是否比血管造影引导下DES置入能带来更好的治疗效果。该荟萃分析旨在分析当前关于IVUS引导和血管造影引导下DES置入治疗LMCA疾病患者的证据。
方法
按照PRISMA指南，通过Scopus、Embase、PubMed、EuropePMC和Clinicaltrials.gov进行文献检索。我们研究中的干预组为接受IVUS引导下经皮冠状动脉介入治疗（PCI）的患者，对照组为仅接受血管造影引导下PCI的患者。比较两组患者的心血管死亡率、全因死亡率、靶病变血运重建、心肌梗死和支架血栓形成情况。
结果
本荟萃分析纳入了11项研究，共24103例患者。与单纯血管造影引导下PCI相比，IVUS引导下PCI与更低的心血管死亡率（风险比（HR）0.39 [95%可信区间0.26, 0.58]，P < 0.001；I²：75%，P < 0.001）和全因死亡率（HR 0.59 [95%可信区间0.53, 0.66]，P < 0.001；I²：0%，P = 0.45）相关。接受IVUS引导下PCI的组心肌梗死发生率更低（HR 0.66 [95%可信区间0.48, 0.90]，P = 0.008；I²：0%，P = 0.98）、靶病变血运重建发生率更低（HR 0.45 [95%可信区间0.38, 0.54]，P < 0.001；I²：41%，P = 0.10）以及支架血栓形成发生率更低（HR 0.38 [95%可信区间0.26, 0.57]，P < 0.001；I²：0%，P =
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