背景:尽管有大量证据支持使用血管内成像(IVI)来指导经皮冠状动脉介入治疗(PCI),对其普遍建议存在担忧。选择性使用IVI指导复杂病变和患者的PCI被认为是一种合理的方法。
方法:我们对随机对照试验(RCTs)进行了系统评价和荟萃分析。Embase,PubMed,系统搜索Cochrane的RCTs,比较IVI引导的PCI和血管造影引导的PCI在高危患者和复杂冠状动脉解剖中的应用.主要结果是主要不良心脏事件(MACE)。使用随机效应模型以95%置信区间(CI)计算风险比(RR)。
结果:共纳入15项RCT,共14,109例患者,并随访15.8个月的加权平均持续时间。IVI指导的PCI与MACE风险降低相关(RR:0.65;95%CI:0.56-0.77;p<0.01),目标血管衰竭(TVF)(RR:0.66;95%CI:0.52-0.84;p<0.01),全因死亡率(RR:0.71;95%CI:0.55-0.91;p<0.01),心血管死亡率(RR:0.47;95%CI:0.34-0.65;p<0.01),支架内血栓形成(RR:0.55;95%CI:0.38-0.79;p<0.01),心肌梗死(RR:0.81;95%CI:0.67-0.98;p=0.03),与血管造影相比,重复血运重建(RR:0.70;95%CI:0.58-0.85;p<0.01)。两组手术相关并发症无显著差异(RR:1.03;95%CI:0.75-1.42;p=0.84)。
结论:与单独的血管造影指导相比,IVI指导复杂病变和高危患者的PCI显着降低了全因死亡率和心血管死亡率。MACE,TVF,支架内血栓形成,心肌梗塞,并重复血运重建。
BACKGROUND: Despite a large body of evidence supporting the use of intravascular imaging (IVI) to guide percutaneous coronary intervention (PCI), concerns exist about its universal recommendation. The selective use of IVI to guide PCI of complex lesions and patients is perceived as a rational approach.
METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs). Embase, PubMed, and Cochrane were systematically searched for RCTs that compared IVI-guided PCI with angiography-guided PCI in high-risk patients and complex coronary anatomies. The primary outcome was major adverse cardiac events (MACE). A random-effects model was used to calculate the risk ratios (RRs) with 95 % confidence intervals (CIs).
RESULTS: A total of 15 RCTs with 14,109 patients were included and followed for a weighted mean duration of 15.8 months. IVI-guided PCI was associated with a decrease in the risk of MACE (RR: 0.65; 95 % CI: 0.56-0.77; p < 0.01), target vessel failure (TVF) (RR: 0.66; 95 % CI: 0.52-0.84; p < 0.01), all-cause mortality (RR: 0.71; 95 % CI: 0.55-0.91; p < 0.01), cardiovascular mortality (RR: 0.47; 95 % CI: 0.34-0.65; p < 0.01), stent thrombosis (RR: 0.55; 95 % CI: 0.38-0.79; p < 0.01), myocardial infarction (RR: 0.81; 95 % CI: 0.67-0.98; p = 0.03), and repeated revascularizations (RR: 0.70; 95 % CI: 0.58-0.85; p < 0.01) compared with angiography. There was no significant difference in procedure-related complications (RR: 1.03; 95 % CI: 0.75-1.42; p = 0.84) between groups.
CONCLUSIONS: Compared with angiographic guidance alone, IVI-guided PCI of complex lesions and high-risk patients significantly reduced all-cause and cardiovascular mortality, MACE, TVF, stent thrombosis, myocardial infarction, and repeat revascularization.