Zito Andrea, Burzotta Francesco, Aurigemma Cristina, Romagnoli Enrico, Paraggio Lazzaro, Fracassi Francesco, Lunardi Mattia, Cappannoli Luigi, Bianchini Francesco, Trani Carlo
Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
Open Heart. 2025 May 27;12(1):e003026. doi: 10.1136/openhrt-2024-003026.
The efficacy of intravascular imaging (IVI) guidance for percutaneous coronary intervention (PCI) represents a contemporary hot topic. PCI in patients with bifurcation coronary lesions and unprotected left main lesions offers specific challenges that, theoretically, may particularly benefit from IVI.
To compare the clinical outcomes between IVI and angiography guidance for PCI in bifurcation and unprotected left main lesions.
Randomised clinical trials (RCTs) comparing IVI (with either intravascular ultrasound or optical coherence tomography) with angiography to guide PCI in patients with bifurcation and unprotected left main lesions were searched in PubMed and Cochrane Central Register of Controlled Trials. Two investigators independently extracted study data. Risk ratios (RRs) were calculated using the random-effects model with inverse variance weighting and the 95% CIs with the modified Knapp-Hartung-Sidik-Jonkman method. The primary outcome was target vessel failure (TVF).
A total of seven RCTs were included, collecting data on 2494 patients in the analysis for bifurcation lesions and 1107 patients in the analysis for unprotected left main lesions. The mean follow-up duration ranged from 12 to 36 months. Compared with angiography guidance, IVI guidance significantly reduced TVF both in bifurcation lesions (RR 0.70, 95% CI 0.53 to 0.92) and unprotected left main lesions (RR 0.55, 95% CI 0.36 to 0.84). The number needed to treat to prevent one TVF with IVI was 27 in bifurcation lesions PCI and 11 in unprotected left main PCI.
In patients undergoing PCI on bifurcation and unprotected left main lesions, IVI guidance significantly reduces the risk of TVF compared with angiography guidance.
CRD42024580321.
血管内成像（IVI）指导经皮冠状动脉介入治疗（PCI）的疗效是当代的一个热门话题。冠状动脉分叉病变和无保护左主干病变患者的PCI存在特殊挑战，从理论上讲，这些患者可能特别受益于IVI。
比较IVI和血管造影指导下PCI治疗分叉病变和无保护左主干病变的临床结局。
在PubMed和Cochrane对照试验中心注册库中检索比较IVI（血管内超声或光学相干断层扫描）与血管造影指导PCI治疗分叉病变和无保护左主干病变患者的随机临床试验（RCT）。两名研究者独立提取研究数据。采用随机效应模型和逆方差加权法计算风险比（RR），并采用改良的Knapp-Hartung-Sidik-Jonkman方法计算95%置信区间（CI）。主要结局是靶血管失败（TVF）。
共纳入7项RCT，分析分叉病变时收集了2494例患者的数据，分析无保护左主干病变时收集了1107例患者的数据。平均随访时间为12至36个月。与血管造影指导相比，IVI指导在分叉病变（RR 0.70，95%CI 0.53至0.92）和无保护左主干病变（RR 0.55，95%CI 0.36至0.84）中均显著降低了TVF。在分叉病变PCI中，采用IVI预防1例TVF所需治疗的患者数为27例，在无保护左主干PCI中为11例。
在接受分叉病变和无保护左主干病变PCI的患者中，与血管造影指导相比，IVI指导显著降低了TVF风险。
PROSPERO注册号：CRD42024580321。
