Abdul Mueez Alam Kayani, Muhammad Faiq Umar, Alan Garcia, Thomas Fretz, Ricky E Lemus-Zamora, Chadi Alraies, Tarique Ahmed, Anas Alharbi, Ramesh Daggubati, Yasar Sattar
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引用次数: 0
Abstract
Background: The presence of coronary artery calcification during percutaneous coronary intervention is associated with an increased risk of complications and poor outcomes. Comparison of the efficacy and safety of intravascular lithotripsy and rotational atherectomy in coronary artery calcification has always been a topic of debate in the literature.
Aim: To present the most recent comparative analysis of these two calcium debulking techniques.
Methods: A search was conducted in online databases, including PubMed, Web of Science and the Cochrane Library. We performed a meta-analysis to find the difference between intravascular lithotripsy and rotational atherectomy regarding all-cause death, myocardial infarction, coronary perforation, slow/no-reflow, target vessel revascularization and procedural success. Using a random effects model, the results were reported as risk ratios.
Results: A total of nine studies with 2203 patients (intravascular lithotripsy, n=1004; rotational atherectomy, n=1199) were selected. Intravascular lithotripsy was associated with a reduced risk of coronary perforation (risk ratio 0.38, 95% confidence interval 0.23-0.62; P=0.0001) and increased procedural success (risk ratio 1.04, 95% confidence interval 1.02-1.06; P=0.0004). There was no significant difference between intravascular lithotripsy and rotational atherectomy in terms of the risk of all cause death, myocardial infarction, target vessel revascularization and slow/no-reflow.
Conclusions: Intravascular lithotripsy was associated with a lower risk of coronary perforation and higher procedural success compared with rotational atherectomy in the management of coronary artery calcification. However, no significant differences were observed between intravascular lithotripsy and RA in terms of all-cause death, myocardial infarction, target vessel revascularization and slow/no-reflow. Given the predominance of retrospective studies in the analysis, randomized controlled trials with long-term follow-up are needed to better identify patient populations most likely to benefit, as well as to compare the long-term clinical outcomes of these two plaque modification strategies.
背景：经皮冠状动脉介入治疗期间冠状动脉钙化的存在与并发症和不良预后的风险增加有关。血管内碎石和旋转动脉粥样硬化切除术治疗冠状动脉钙化的疗效和安全性的比较一直是文献中争论的话题。目的：介绍两种钙减体积技术的最新对比分析。方法：检索PubMed、Web of Science、Cochrane Library等在线数据库。我们进行了一项荟萃分析，以发现血管内碎石术和旋转动脉粥样硬化切除术在全因死亡、心肌梗死、冠状动脉穿孔、缓慢/无回流、靶血管重建术和手术成功方面的差异。采用随机效应模型，结果报告为风险比。结果：共纳入9项研究2203例患者（血管内碎石术，1004例；旋转动脉粥样硬化切除术，1199例）。血管内碎石术降低了冠状动脉穿孔的风险（风险比0.38,95%可信区间0.23-0.62；P=0.0001），增加了手术成功率（风险比1.04,95%可信区间1.02-1.06；P=0.0004）。在全因死亡、心肌梗死、靶血管重建术和慢/无血流风险方面，血管内碎石术和旋转动脉粥样硬化切除术之间没有显著差异。结论：与旋转动脉粥样硬化切除术相比，血管内碎石术在治疗冠状动脉钙化方面具有较低的冠状动脉穿孔风险和较高的手术成功率。然而，在全因死亡、心肌梗死、靶血管重建术和慢/无血流方面，血管内碎石术和RA之间没有明显差异。鉴于回顾性研究在分析中的优势，需要进行长期随访的随机对照试验，以更好地确定最有可能受益的患者群体，并比较这两种斑块修饰策略的长期临床结果。
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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