■血管造影程序存在一些技术限制,包括特定位置的次优可视化和仅提供有关血管腔轮廓的信息的血管造影,而血管内超声(IVUS)提供有关冠状动脉血管病变的壁组成的信息。最近的试验证明IVUS优于标准血管造影,我们的荟萃分析旨在评估和总结目前的证据,即在左冠状动脉主干(LMCA)疾病患者中,IVUS引导的药物洗脱支架(DES)置入是否比血管造影引导的DES置入产生更好的结局.这项荟萃分析旨在分析LMCA疾病患者IVUS引导和血管造影引导药物洗脱支架(DES)放置的当前证据。
■使用Scopus进行文献检索,Embase,PubMed,EuropePMC,和Clinicaltrials.gov使用PRISMA指南。我们研究中的干预组是接受IVUS引导的经皮冠状动脉介入治疗(PCI)的患者,对照组是接受血管造影单独引导的PCI的患者。心血管死亡率,全因死亡率,靶病变血运重建,心肌梗塞,比较两组支架内血栓形成情况。
■本荟萃分析纳入了11项研究,包括24,103名患者。IVUS指导的PCI与较低的心血管死亡率相关(风险比(HR)0.39[95%CI0.26,0.58],p<0.001;I2:75%,p<0.001)和全因死亡率(HR0.59[95%CI0.53,0.66],p<0.001;I2:0%,p=0.45)与仅血管造影引导的PCI相比。接受IVUS引导PCI的组心肌梗死发生率较低(HR0.66[95%CI0.48,0.90],p=0.008;I2:0%,p=0.98),靶病变血运重建(HR0.45[95%CI0.38,0.54],p<0.001;I2:41%,p=0.10)和支架血栓形成(HR0.38[95%CI0.26,0.57],p<0.001;I2:0%,p=0.50)与对照组相比。
■我们的荟萃分析表明,IVUS引导的DES放置具有较低的心血管死亡率,全因死亡率,靶病变血运重建,心肌梗塞,和支架内血栓形成比血管造影引导下的DES植入。
UNASSIGNED: Several technical limitations exist in angiography procedures, including suboptimal visualization of a particular location and angiography only providing information about the contour of the vascular lumen, while intravascular ultrasound (IVUS) provides information regarding wall composition on coronary vascular lesions. With recent trials demonstrating IVUS benefits over standard angiography, our meta-analysis aimedto evaluate and summarize the current evidence on whether IVUS-guided drug-eluting stent (DES) placement resulted in better outcomes than the angiography-guided DES placement in patients with left main coronary artery (LMCA) disease. This meta-analysis aimed to analyze the current evidence on the IVUS-guided and angiography-guided drug-eluting stent (DES) placement in patients with LMCA disease.
UNASSIGNED: Literature searching was performed using Scopus, Embase, PubMed, EuropePMC, and Clinicaltrials.gov using PRISMA guidelines. The intervention group in our study are patients undergoing IVUS-guided percutaneous coronary intervention (PCI) and the control group are patients undergoing angiography alone-guided PCI. Cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial
infarction, and stent thrombosis were compared between the two groups.
UNASSIGNED: There were 11 studies comprising 24,103 patients included in this meta-analysis. IVUS-guided PCI was associated with lower cardiovascular mortality (hazard ratio (HR) 0.39 [95% CI 0.26, 0.58], p < 0.001; I 2 : 75%, p < 0.001) and all-cause mortality (HR 0.59 [95% CI 0.53, 0.66], p < 0.001; I 2 : 0%, p = 0.45) compared to angiography alone guided PCI. The group receiving IVUS guided PCI has a lower incidence of myocardial
infarction (HR 0.66 [95% CI 0.48, 0.90], p = 0.008; I 2 : 0%, p = 0.98), target lesion revascularization (HR 0.45 [95% CI 0.38, 0.54], p < 0.001; I 2 : 41%, p = 0.10) and stent thrombosis (HR 0.38 [95% CI 0.26, 0.57], p < 0.001; I 2 : 0%, p = 0.50) compared to the control group.
UNASSIGNED: Our meta-analysis demonstrated that IVUS-guided DES placement had lower cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial
infarction, and stent thrombosis than angiography-guided DES implantation.