传统的血管造影仅显示支架植入过程中冠状动脉的二维图像。然而,血管内成像可以显示血管壁的结构,斑块特征。本文旨在评估血管内成像引导药物洗脱支架(DES)植入的疗效。
我们对血管内成像引导的随机对照试验进行了系统评价和荟萃分析,包括血管内超声或光学相干断层扫描和传统血管造影引导下的DES植入患者。PubMed的数据库,EMBASE,科学网,搜索了Cochrane图书馆.主要结果是靶病变血运重建(TLR)。次要结果包括目标血管血运重建(TVR),心肌梗死(MI),支架内血栓形成(ST),心脏死亡,全因死亡,以及6-24个月随访期间的主要不良心脏事件(MACE)。固定效应模型用于计算结果事件的相对风险(RR)和95%置信区间。同时,试验序列分析用于评估结果.
这项荟萃分析包括14项随机对照试验,共7307例患者。与血管造影引导相比,血管内成像引导的DES植入可显著降低TLR的风险(RR0.63,0.49-0.82,P=0.0004),TVR(RR0.66,0.52-0.85,P=0.001),心脏死亡(RR0.58;0.38-0.89;P=0.01),MACE(RR0.67,0.57-0.79;P<0.00001)和ST(RR0.43,0.24-0.78;P=0.005)。而MI(RR0.77,0.57-1.05,P=0.10)和全因死亡(RR0.87,0.58-1.30,P=0.50)没有显着差异。
与血管造影相比,血管内成像引导的DES植入与冠心病患者更好的临床预后相关,尤其是复杂的病变(由PROSPERO注册,CRD42021289205)。
BACKGROUND: Traditional angiography only displays two-dimensional images of the coronary arteries during stent implantation. However, intravascular imaging can show the structure of the vascular wall, plaque characteristics. This article aims to evaluate the efficacy of intravascular imaging-guided drug-eluting stent (
DES) implantation.
METHODS: We conducted a systematic
review and meta-analysis of randomized controlled trials of intravascular imaging-guided, including patients with
DES implantation guided by intravascular ultrasound or optical coherence tomography and traditional angiography. The databases of PubMed, EMBASE, web of science, and Cochrane Library were searched. The primary outcome was target lesion revascularization (TLR). The secondary outcomes included the target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), cardiac death, all-cause death, and the major adverse cardiac events (MACE) during the 6-24 months follow-up. The fixed-effects model was used to calculate the relative risk (RR) and 95% confidence interval of the outcome event. Meanwhile, the trial sequence analysis was employed to evaluate the results.
RESULTS: This meta-analysis included fourteen randomized controlled trials with 7307 patients. Compared with angiography-guided, intravascular imaging-guided
DES implantation can significantly reduce the risk of TLR (RR 0.63, 0.49-0.82, P = 0.0004), TVR (RR 0.66, 0.52-0.85, P = 0.001), cardiac death (RR 0.58; 0.38-0.89; P = 0.01), MACE (RR 0.67, 0.57-0.79; P < 0.00001) and ST (RR 0.43, 0.24-0.78; P = 0.005). While there was no significant difference regarding MI (RR 0.77, 0.57-1.05, P = 0.10) and all-cause death (RR 0.87, 0.58-1.30, P = 0.50).
CONCLUSIONS: Compared with angiography, intravascular imaging-guided
DES implantation is associated with better clinical outcomes in patients with coronary artery disease, especially complex lesions (Registered by PROSPERO, CRD 42021289205).