Evaluating IVUS-guided PCI in acute myocardial infarction: a comparative meta-analysis with angiography guidance.

IF 2.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Acta cardiologica Pub Date : 2025-08-06 DOI:10.1080/00015385.2025.2529133

Hongjuan Fang, Ting Wang, Lina Zhang, Dongxu Qi, Xia Peng, Ying Chang

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引用次数: 0

Abstract

Background: Intravascular ultrasound (IVUS) guidance shows benefits in various PCI settings; however, its impact in acute myocardial infarction (AMI) patients is not fully understood. This study aims to systematically review and meta-analyse the outcomes of IVUS-guided versus angiography-guided PCI in AMI.

Methods: A comprehensive search across PubMed, Cochrane Library, Embase, Web of Science, and CNKI identified studies comparing IVUS- and angiography-guided PCI in AMI patients. Primary outcomes were all-cause mortality, major adverse cardiac events (MACE), cardiac death, and target vessel revascularization (TVR). A random-effects model was used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).

Results: Nine studies with 838,902 patients (38,949 IVUS-guided and 796,953 angiography-guided) were included. IVUS-guided PCI significantly reduced all-cause mortality (RR 0.74, 95% CI 0.70-0.78, p < 0.001), MACE (RR 0.88, 95% CI 0.82-0.95, p = 0.001), cardiac death (RR 0.67, 95% CI 0.52-0.87, p = 0.003), and TVR (RR 0.86, 95% CI 0.75-0.98, p = 0.024) compared to angiography-guided PCI. Moderate heterogeneity was observed, but sensitivity analyses confirmed result stability.

Conclusion: This meta-analysis indicates that IVUS-guided PCI in AMI patients improves clinical outcomes, including lower mortality, MACE, cardiac death, and TVR rates, compared to angiography guidance. Further research is needed to address barriers to wider IVUS adoption.

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评估ivus引导的急性心肌梗死PCI：与血管造影指导的比较荟萃分析。

背景：血管内超声（IVUS）指导在各种PCI设置中显示益处；然而，其对急性心肌梗死（AMI）患者的影响尚不完全清楚。本研究旨在系统回顾和荟萃分析ivus引导与血管造影引导的PCI治疗AMI的结果。方法：对PubMed、Cochrane Library、Embase、Web of Science和CNKI进行综合检索，确定了比较IVUS和血管造影引导下AMI患者PCI的研究。主要结局是全因死亡率、主要不良心脏事件（MACE）、心源性死亡和靶血管重建术（TVR）。采用随机效应模型计算95%置信区间（ci）的合并风险比（rr）。结果：纳入9项研究，共838902例患者（ivus引导下38949例，血管造影引导下796953例）。与血管造影引导下的PCI相比，ivus引导下的PCI显著降低了全因死亡率（RR 0.74, 95% CI 0.70-0.78, p p = 0.001）、心源性死亡（RR 0.67, 95% CI 0.52-0.87, p = 0.003）和TVR （RR 0.86, 95% CI 0.75-0.98, p = 0.024）。观察到中度异质性，但敏感性分析证实了结果的稳定性。结论：该荟萃分析表明，与血管造影指导相比，ivus引导的AMI患者PCI改善了临床结果，包括更低的死亡率、MACE、心源性死亡和TVR率。需要进一步的研究来解决广泛采用静脉注射药物的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta cardiologica 医学-心血管系统

CiteScore

2.50

自引率

12.50%

发文量

115

审稿时长

2 months

期刊介绍： Acta Cardiologica is an international journal. It publishes bi-monthly original, peer-reviewed articles on all aspects of cardiovascular disease including observational studies, clinical trials, experimental investigations with clear clinical relevance and tutorials.