Intravascular Imaging Improves Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions: A Meta-Analysis of Randomized Controlled Trials

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Wilton F. Gomes MD, MSc , Djinane S. Zerlotto MD , Patricia Viana MD , Larissa A. Lucena MD , Pedro E.P. Carvalho MD , Pedro F.G. Nicz MD , Deborah C. Nercolini MD, MSc , Marcelo H. Ribeiro MD, PhD , Alexandre S. Quadros MD, MSc , Ronaldo R.L. Bueno MD, PhD , Ricardo A. Costa MD, PhD , Breno A.A. Falcão MD, PhD
{"title":"Intravascular Imaging Improves Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions: A Meta-Analysis of Randomized Controlled Trials","authors":"Wilton F. Gomes MD, MSc ,&nbsp;Djinane S. Zerlotto MD ,&nbsp;Patricia Viana MD ,&nbsp;Larissa A. Lucena MD ,&nbsp;Pedro E.P. Carvalho MD ,&nbsp;Pedro F.G. Nicz MD ,&nbsp;Deborah C. Nercolini MD, MSc ,&nbsp;Marcelo H. Ribeiro MD, PhD ,&nbsp;Alexandre S. Quadros MD, MSc ,&nbsp;Ronaldo R.L. Bueno MD, PhD ,&nbsp;Ricardo A. Costa MD, PhD ,&nbsp;Breno A.A. Falcão MD, PhD","doi":"10.1016/j.amjcard.2025.03.011","DOIUrl":null,"url":null,"abstract":"<div><div>Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"245 ","pages":"Pages 62-70"},"PeriodicalIF":2.3000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002914925001481","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.
血管内成像改善经皮冠状动脉介入治疗慢性全闭塞的临床结果:随机对照试验的荟萃分析。
比较血管内成像(IVI)引导下的经皮冠状动脉介入治疗(PCI)与血管造影引导下的PCI治疗慢性全闭塞(CTOs)的临床数据有限。本研究旨在比较ivi引导与血管造影引导下的PCI治疗CTOs患者的临床结果。进行了系统回顾和荟萃分析,以确定在CTO人群中比较ivi引导和血管造影引导PCI的随机对照试验(rct)。主要终点是主要心脏不良事件(MACE)的发生率,即死亡/心源性死亡、心肌梗死(MI)和靶血管重建术(TVR)的复合发生率。次要结局包括MACE的各个组成部分。对血管内超声(IVUS)和光学相干断层扫描(OCT)进行预先指定的亚组分析。我们分析了5项随机对照试验,包括1296例患者,其中713例(55%)接受了ivi引导下的PCI。在1至3年期间,ivi引导下PCI组的MACE显著降低(7.2% vs. 13%;相对危险度[RR] 0.55;95%置信区间[CI] 0.35-0.88;p = 0.012;²= 31%)。在二次分析中,IVI组TVR发生率较低(3.1% vs. 6.7%;RR 0.52;95% ci 0.29-0.97;p = 0.038)。心肌梗死或死亡/心源性死亡没有统计学差异。在IVUS亚组中,IVUS引导下PCI组的MACE也较低(8.4%比14.3%;RR 0.59;95% ci 0.37-0.91;p = 0.019)。一项试验序列分析表明I型错误的可能性很低。总之,与血管造影引导下的PCI相比,ivi引导下的PCI治疗CTOs的临床结果有所改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
American Journal of Cardiology
American Journal of Cardiology 医学-心血管系统
CiteScore
4.00
自引率
3.60%
发文量
698
审稿时长
33 days
期刊介绍: Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信