Intravascular Ultrasound Imaging–Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis
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- Fahed Darmoch
- Beth Israel Deaconess Medical Center/Harvard School of Medicine Boston MA
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- M. Chadi Alraies
- Detroit Medical Center Wayne State University Detroit MI
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- Yasser Al‐Khadra
- Cleveland Clinic Cleveland OH
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- Homam Moussa Pacha
- MedStar Washington Hospital Center Washington DC
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- Duane S. Pinto
- Beth Israel Deaconess Medical Center/Harvard School of Medicine Boston MA
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- Eric A. Osborn
- Beth Israel Deaconess Medical Center/Harvard School of Medicine Boston MA
説明
<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Intravascular ultrasound ( <jats:styled-content style="fixed-case">IVUS</jats:styled-content> ) guidance during percutaneous coronary intervention ( <jats:styled-content style="fixed-case">PCI</jats:styled-content> ) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of <jats:styled-content style="fixed-case">PCI</jats:styled-content> . However, the long‐term beneficial effect of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> over <jats:styled-content style="fixed-case">PCI</jats:styled-content> guided by coronary angiography ( <jats:styled-content style="fixed-case">CA</jats:styled-content> ) alone remains under question. We sought to investigate the outcomes of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> ‐guided compared with <jats:styled-content style="fixed-case">CA</jats:styled-content> ‐guided <jats:styled-content style="fixed-case">PCI</jats:styled-content> . </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> We performed a comprehensive search of PubMed, Medline, and Cochrane Central Register, looking for randomized controlled trials and observational studies that compared <jats:styled-content style="fixed-case">PCI</jats:styled-content> outcomes of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> with <jats:styled-content style="fixed-case">CA</jats:styled-content> . Data were aggregated for the primary outcome measure using the random‐effects model as pooled risk ratio ( <jats:styled-content style="fixed-case">RR</jats:styled-content> ). The primary outcomes were the rate of cardiovascular death, need for target lesion revascularization, occurrence of myocardial infarction, and rate of stent thrombosis. A total of 19 studies met the inclusion criteria, comprising 27 610 patients divided into <jats:styled-content style="fixed-case">IVUS</jats:styled-content> (n=11 513) and <jats:styled-content style="fixed-case">CA</jats:styled-content> (n=16 097). Compared with standard <jats:styled-content style="fixed-case">CA</jats:styled-content> ‐guided <jats:styled-content style="fixed-case">PCI</jats:styled-content> , we found that the risks of cardiovascular death ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.63; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.54–0.73), myocardial infarction ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.71; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.58–0.86), target lesion revascularization ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.81; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.70–0.94), and stent thrombosis ( <jats:styled-content style="fixed-case">RR</jats:styled-content> , 0.57; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.41–0.79) were all significantly lower using <jats:styled-content style="fixed-case">IVUS</jats:styled-content> guidance. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Compared with standard <jats:styled-content style="fixed-case">CA</jats:styled-content> ‐guided <jats:styled-content style="fixed-case">PCI</jats:styled-content> , the use of <jats:styled-content style="fixed-case">IVUS</jats:styled-content> imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis. </jats:p> </jats:sec>
収録刊行物
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- Journal of the American Heart Association
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Journal of the American Heart Association 9 (5), e013678-, 2020-03-03
Ovid Technologies (Wolters Kluwer Health)