急性冠状动脉综合征中冠状动脉血运重建的血管内成像、生理评估与血管造影比较：一项系统评价与网状Meta分析
Comparison of intravascular imaging, physiological assessment and angiography for coronary revascularization in acute coronary syndrome: a systematic review and network meta-analysis.
作者信息
Liu Xuan-Yan, Ye Bin-Hua, Wu Xian-Dan, Lin Yue, Lin Xian, Li Yan-Yan, Sun Jing-Chao
机构信息
Department of General Medicine, The First People's Hospital of Wenling, Taizhou, Zhejiang, China.
Department of Cardiology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China.
出版信息
Front Cardiovasc Med. 2025 Jul 21;12:1604050. doi: 10.3389/fcvm.2025.1604050. eCollection 2025.
BACKGROUND
The optimal percutaneous coronary intervention (PCI) technique to treat acute coronary syndrome (ACS) requires further investigation. This network meta-analysis evaluated the effects of physiological assessment and intravascular imaging techniques on the prevalence of adverse cardiac outcomes following PCIs.
METHODS
We reviewed PubMed, Cochrane, and EMBASE databases for the purpose of identifying all randomized control trials published up to October 30, 2024, comparing the impact of intravascular imaging, physiology assessment, or angiography techniques on outcomes. The primary outcome for this research was major adverse cardiovascular events (MACE) occurrences. Each PCI strategy was ranked the risk ratio (RR) at the 95% confidence interval (95% CI) for developing MACE.
RESULTS
Twenty-eight RCTs with 18,221 patients were identified. Compared with angiography, intravascular ultrasound (IVUS)- (RR: 0.62; 95%CI: 0.46-0.85) and fractional flow reserve (FFR)-guided PCI (RR: 0.62; 95%CI: 0.46-0.85) reduced the risk of MACE. Patients who received quantitative flow ratio (QFR)-guided PCI experienced lower all-cause mortality (RR: 0.25; 95%CI: 0.07-0.92) vs. those receiving angiography. Similarly, the RR decreased to 0.64 after using FFR-guided PCI vs. angiographic procedures (95% CI: 0.44-0.91). Compared to angiography, the subgroup analysis showed inconsistent results for IVUS-guided PCI in preventing MACE for both the optimization (RR: 0.60; 95%CI: 0.49-0.74) and decision-making (RR: 0.55; 95%CI: 0.05-6.18). The likelihood of developing MACE was lower for FFR-guided CR than for angiography-guide culprit-only PCIs (RR-0.72; 95%CI: 0.53-0.97), as confirmed by sensitivity assessment results. The research unveiled no statistically significant differences between FFR-guided culprit-only PCIs and culprit-only PCIs or angiography-guided CR.
CONCLUSION
IVUS- and FFR-guided PCI lowers the MACE risk in patients with ACS. In addition, IVUS achieved the best results in ACS patients undergoing PCI.
SYSTEMATIC REVIEW REGISTRATION
INPLASY (inplasy.com), INPLASY202420092.
背景
治疗急性冠状动脉综合征（ACS）的最佳经皮冠状动脉介入治疗（PCI）技术仍需进一步研究。这项网络荟萃分析评估了生理评估和血管内成像技术对PCI术后不良心脏事件发生率的影响。
方法
我们检索了PubMed、Cochrane和EMBASE数据库，以识别截至2024年10月30日发表的所有随机对照试验，比较血管内成像、生理评估或血管造影技术对结局的影响。本研究的主要结局是主要不良心血管事件（MACE）的发生情况。每种PCI策略根据发生MACE的风险比（RR）及其95%置信区间（95%CI）进行排序。
结果
共纳入28项随机对照试验，涉及18221例患者。与血管造影相比，血管内超声（IVUS）引导的PCI（RR：0.62；95%CI：0.46-0.85）和血流储备分数（FFR）引导的PCI（RR：0.62；95%CI：0.46-0.85）降低了MACE风险。接受定量血流比（QFR）引导的PCI患者的全因死亡率低于接受血管造影的患者（RR：0.25；95%CI：0.07-0.92）。同样，与血管造影术相比，使用FFR引导的PCI后RR降至0.64（95%CI：0.44-0.91）。亚组分析显示，与血管造影相比，IVUS引导的PCI在优化（RR：0.60；95%CI：0.49-0.74）和决策制定（RR：0.55；95%CI：0.05-6.18）方面预防MACE的结果不一致。敏感性评估结果证实，FFR引导的罪犯血管PCI发生MACE的可能性低于血管造影引导的仅处理罪犯血管的PCI（RR：0.72；95%CI：0.5
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