超声与血管造影引导下左主干支架置入术临床试验和观察性研究的最新荟萃分析

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Nimra Ashraf, Muhammad Ahmed Ilyas, Jaghat Ram, Ejaz Ul Haq, Zaryab Ahmed Khuwaja, Gohar Riaz, Ahmed Raheem
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引用次数: 0

摘要

目的:这项更新的荟萃分析旨在巩固比较血管内超声(IVUS)引导下LMCA支架置入与传统血管造影引导下LMCA支架置入临床结果的临床证据。方法:我们纳入了发表在同行评议的英文期刊上的“随机对照试验”和“观察性研究”,比较了“ivus引导”和“血管造影引导”下使用“药物洗脱支架(DES)”进行LMCA血运重建术的临床结果。主要结局是“主要不良心血管事件(MACE)”,次要结局变量包括“全因死亡率”、“心肌梗死(MI)”、“靶血管/病变血运重建术(TVR/TLR)”和“支架血栓形成(ST)”。采用“Mantel-Haenszel法”计算各结局变量的风险比(rr)。结果:该分析包括9项研究,共涉及5344例患者,其中2282例接受“ivus引导”的LMCA支架置入,3062例接受“血管造影引导”的LMCA支架置入。与血管造影引导下的LMCA支架置入相比,ivus引导下的LMCA支架置入MACE的风险显著降低,RR为0.46 [95% CI: 0.27 - 0.79]。然而,高度异质性(I2=94%;在纳入的研究中观察到P<0.01)。此外,ivus引导下的LMCA支架置入与全因死亡率、心肌梗死和ST的显著降低相关,其rr分别为0.38[0.21 - 0.66]、0.45[0.26 - 0.77]和0.24[0.10 - 0.57]。ivus引导下与血管造影引导下LMCA支架术TVR/TLR差异无统计学意义,RR为0.64[0.27 ~ 1.51]。结论:与传统的“血管造影引导”LMCA支架植入术相比,“ivus引导”下使用DES的LMCA血管重建术与MACE、死亡、心肌梗死和ST的风险较低相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An Updated Meta-Analysis of Clinical Trials and Observational Studies of Intravascular Ultrasound- versus Angiography-guided Left Main Stenting
Objectives: This updated meta-analysis aimed to consolidate clinical evidence comparing the clinical outcomes of intravascular ultrasound (IVUS)-guided LMCA stenting versus conventional angiography-guided LMCA stenting. Methodology: We included “randomized controlled trials” and “observational studies” published in peer-reviewed English language journals that compared the clinical outcomes of LMCA revascularization using “drug-eluting stents (DES)” via “IVUS-guided” versus “angiography-guided” stenting. The primary outcome of interest was “major adverse cardiovascular events (MACE)”, while secondary outcome variables included “all-cause mortality”, “myocardial infarction (MI)”, “target vessel/lesion revascularization (TVR/TLR)”, and “stent thrombosis (ST)”. Risk ratios (RRs) for each outcome variable were calculated using the “Mantel-Haenszel method”. Results: The analysis included nine studies involving a total of 5,344 patients, with 2,282 undergoing “IVUS-guided” LMCA stenting and 3,062 undergoing “angiography-guided” LMCA stenting. “IVUS-guided” LMCA stenting showed a significant reduction in the risk of MACE compared to “angiography-guided” LMCA stenting, with a RR of 0.46 [95% CI: 0.27 - 0.79]. However, a high level of heterogeneity (I2=94%; p<0.01) was observed among the included studies. Additionally, “IVUS-guided” LMCA stenting was associated with significant reductions in all-cause mortality, MI, and ST, with RRs of 0.38 [0.21 - 0.66], 0.45 [0.26 - 0.77], and 0.24 [0.10 - 0.57], respectively. There was no statistically significant difference in TVR/TLR between “IVUS-guided” and “angiography-guided” LMCA stenting, with an RR of 0.64 [0.27 - 1.51]. Conclusion: “IVUS-guided” LMCA revascularization using DES was associated with a lower risk of MACE, death, MI, and ST compared to conventional “angiography-guided” LMCA stenting.
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来源期刊
Pakistan Heart Journal
Pakistan Heart Journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
0.20
自引率
0.00%
发文量
64
审稿时长
6 weeks
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