Al Hayek Mohammad, Beshr Ibrahem A, Beshr Mohammed S
Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
Heliyon. 2024 Dec 30;11(1):e41557. doi: 10.1016/j.heliyon.2024.e41557. eCollection 2025 Jan 15.
Dynamic Coronary Roadmap (DCR) is a new PCI method that may reduce contrast dose and contrast-associated acute kidney injury (CA-AKI) risk. This paper evaluates DCR-guided PCI versus standard angiography PCI for contrast usage, procedure time, and CA-AKI risk.
On May 1, 2024, we searched PubMed, Scopus, Embase, Cochrane Library, and clinicaltrials.gov for clinical trials or observational studies comparing DCR-guided PCI to standard angiography PCI. Outcomes were contrast media usage, radiation time, dose-area product, air kerma, radiation dose, post-PCI eGFR, AKI incidence, and procedure success. We used a random-effects model and analyzed outcomes using standardized mean difference (SMD) and odds ratio (OR).
Out of 1679 screened articles, only 5 were eligible, encompassing 941 patients. Findings show DCR-guided PCI significantly reduces contrast volume (SMD = -1.12, 95 % CI: 1.75 to -0.50, p = 0.0004), dose-area product (SMD = -0.71, 95 % CI: 1.25 to -0.17, p = 0.01), air kerma (SMD = -1.62, 95 % CI: 2.70 to -0.54), and radiation time (SMD = -0.75, 95 % CI: 1.32 to -0.18, p = 0.003) compared to standard angiography PCI. Despite lower incidence of acute kidney injury (AKI) in the DCR-guided PCI group, the odds ratio did not show statistical significance. Post-PCI eGFR also did not differ significantly between the two groups. Procedural success rates were similar, both exceeding 99 %.
In this paper, we found that DCR-guided PCI is superior to conventional PCI in terms of contrast medium volume and radiation time. Future randomized controlled trials with larger sample sizes are needed to confirm these findings, especially in patients with kidney disease.
动态冠状动脉造影导航（DCR）是一种新的经皮冠状动脉介入治疗（PCI）方法，可能会降低造影剂用量和造影剂相关急性肾损伤（CA-AKI）风险。本文评估了DCR引导下的PCI与标准血管造影PCI在造影剂使用、手术时间和CA-AKI风险方面的差异。
2024年5月1日，我们检索了PubMed、Scopus、Embase、Cochrane图书馆和clinicaltrials.gov，以查找比较DCR引导下的PCI与标准血管造影PCI的临床试验或观察性研究。观察指标包括造影剂使用情况、放射时间、剂量面积乘积、空气比释动能、辐射剂量、PCI术后估算肾小球滤过率（eGFR）、急性肾损伤（AKI）发生率及手术成功率。我们采用随机效应模型，并使用标准化均数差（SMD）和比值比（OR）分析观察指标。
在1679篇筛选出的文章中，仅有5篇符合条件，涉及941例患者。研究结果显示，与标准血管造影PCI相比，DCR引导下的PCI显著降低了造影剂用量（SMD = -1.12，95%CI：-1.75至-0.50，p = 0.0004）、剂量面积乘积（SMD = -0.71，95%CI：-1.25至-0.17，p = 0.01）、空气比释动能（SMD = -1.62，95%CI：-2.70至-0.54）和放射时间（SMD = -0.75，95%CI：-1.32至-0.18，p = 0.003）。尽管DCR引导下的PCI组急性肾损伤（AKI）发生率较低，但比值比未显示出统计学意义。两组PCI术后eGFR也无显著差异。手术成功率相似，均超过99%。
在本文中，我们发现DCR引导下的PCI在造影剂用量和放射时间方面优于传统PCI。需要开展样本量更大的未来随机对照试验来证实这些发现，尤其是在肾病患者中。
