Shariff Mariam, Kumar Ashish, Kansara Tikal, Majmundar Monil, Doshi Rajkumar, Stulak John M, Kapadia Samir R, Reed Grant W, Puri Rishi, Kalra Ankur
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 30;1(6):100507. doi: 10.1016/j.jscai.2022.100507. eCollection 2022 Nov-Dec.
The current advances in coronary imaging with the introduction of intravascular ultrasound (IVUS), and more recently, optical coherence tomography (OCT) have overcome the limitations of coronary angiography.
This study aimed to conduct a comprehensive network meta-analysis of randomized clinical trials to report clinical outcomes among patients undergoing drug-eluting stent (DES) implantation either by IVUS- or OCT-guided technique or angiography alone.
PubMed/MEDLINE and EMBASE databases were searched systematically for all relevant published randomized clinical trials from the inception of the respective database to October 15th, 2021. The outcomes of interest assessed in this meta-analysis were major adverse cardiac events, myocardial infarction, target vessel revascularization, all-cause mortality, and cardiovascular mortality. All the endpoints were expressed as odds ratio (OR) with 95% CI. The network diagrams were computed using the OR as an effective measure. All statistical analyses were carried out in R statistical software version 4.0.3.
A total of 14 randomized clinical trials were included in our meta-analysis. In patient undergoing DES implantation, angiography alone was associated with higher odds of major adverse cardiac events (OR, 1.62; 95% CI, 1.17-2.24), target vessel revascularization (OR, 1.60; 95% CI, 1.21-2.13) and cardiovascular mortality (OR, 1.97; 95% CI, 1.25-3.11). However, OCT demonstrated similar odds of major adverse cardiac events, cardiovascular mortality, and target vessel revascularization compared with IVUS. The odds of myocardial infarction and all-cause mortality were similar among all the 3 groups.
Although angiography alone was associated with worse outcomes than IVUS in a patient undergoing DES implantation, no difference in outcome was noted between patients undergoing DES implantation with OCT compared with IVUS. Advanced intracoronary imaging use should be encouraged to prevent excess mortality and morbidity.
随着血管内超声（IVUS）的引入，以及最近光学相干断层扫描（OCT）技术的出现，冠状动脉成像技术取得了显著进展，克服了冠状动脉造影的局限性。
本研究旨在对随机临床试验进行全面的网状荟萃分析，以报告接受药物洗脱支架（DES）植入的患者，采用IVUS或OCT引导技术或单纯血管造影的临床结局。
系统检索PubMed/MEDLINE和EMBASE数据库，查找从各数据库建立至2021年10月15日期间所有相关的已发表随机临床试验。本荟萃分析评估的感兴趣结局包括主要不良心脏事件、心肌梗死、靶血管血运重建、全因死亡率和心血管死亡率。所有终点均以比值比（OR）及95%置信区间（CI）表示。使用OR作为有效指标计算网状图。所有统计分析均在R统计软件4.0.3版本中进行。
我们的荟萃分析共纳入14项随机临床试验。在接受DES植入的患者中，单纯血管造影与主要不良心脏事件（OR，1.62；95%CI，1.17 - 2.24）、靶血管血运重建（OR，1.60；95%CI，1.21 - 2.13）和心血管死亡率（OR，1.97；95%CI，1.25 - 3.11）的较高比值相关。然而，与IVUS相比，OCT显示主要不良心脏事件、心血管死亡率和靶血管血运重建的比值相似。三组之间心肌梗死和全因死亡率的比值相似。
尽管在接受DES植入的患者中，单纯血管造影的结局比IVUS差，但接受DES植入的患者中，OCT与IVUS相比，结局并无差异。应鼓励使用先进的冠状动脉内成像技术，以预防过高的死亡率和发病率。
