血管内超声引导与血管造影引导下肢动脉疾病血管内治疗的 Meta 分析。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2024-12-12 DOI:10.1016/j.amjcard.2024.12.012

Jae-Sik Jang MD, PhD , Han-Young Jin MD, PhD , Young-Ah Park MD , Tae-Hyun Yang MD, PhD , Jeong-Sook Seo MD, PhD , Dae-Kyeong Kim MD, PhD , Jin-Hong Wi MD, PhD

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引用次数: 0

摘要

血管内超声（IVUS）提供了病变形态的精确信息，增强了血管内治疗（EVT）的优化。然而，IVUS对evt持续时间和临床结果的影响仍不确定。本系统综述和荟萃分析的目的是评估ivus引导的EVT与血管造影引导的EVT的疗效。我们对ivus引导和血管造影引导下的EVT进行了荟萃分析。主要终点是二元再狭窄，次要终点包括再干预、主要截肢、死亡或截肢以及主要肢体不良事件（MALE）。这项荟萃分析包括19项研究，涉及800,452名患者。与血管造影引导下的EVT相比，ivus引导下的EVT显著降低了二元再狭窄的风险（RR: 0.63, CI: 0.43-0.91, p=0.02）。它还降低了再干预（RR: 0.59, CI: 0.39-0.90, p=0.01）、主要截肢（RR: 0.85, CI: 0.74-0.98, p=0.02）、死亡或截肢（RR: 0.72, CI: 0.56-0.91, p=0.007）和男性（RR: 0.52, CI: 0.28-0.94, p=0.03）的风险。股腘动脉疾病的亚组分析显示，IVUS指导对二元再狭窄（RR: 0.63, 95% CI: 0.42-0.94, p=0.03）、再干预（RR: 0.51, CI: 0.33-0.80, p=0.003）、主要截肢（RR: 0.85, CI: 0.73-0.99, p=0.04）、死亡或截肢（RR: 0.68, CI: 0.51-0.90, p=0.007）和男性（RR: 0.51, CI: 0.27-0.96, p=0.04）均有一致的益处。使用药物包被装置的研究的敏感性分析也显示了IVUS指导对二元再狭窄的一致益处。总之，与血管造影相比，ivus引导下的EVT在包括股腘动脉疾病在内的下肢动脉疾病中，在二元再狭窄、再干预、大截肢、死亡或截肢以及MALE方面提供了更好的临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Meta-Analysis of Intravascular Ultrasound-Guided Versus Angiography-Guided Endovascular Treatment in Lower Extremity Artery Disease

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Meta-Analysis of Intravascular Ultrasound-Guided Versus Angiography-Guided Endovascular Treatment in Lower Extremity Artery Disease

Intravascular ultrasound (IVUS) offers precise information about lesion morphology and enhances the optimization of endovascular treatments (EVT). Nevertheless, the impact of IVUS on the durability of EVTs and clinical outcomes remains uncertain. The aim of this systematic review and meta-analysis was to evaluate the efficacy of IVUS-guided EVT compared with angiography-guided EVT. We conducted a meta-analysis of trials comparing IVUS-guided and angiography-guided EVT. The primary end point was binary restenosis, whereas the secondary end points included reintervention, major amputation, death or amputation, and major adverse limb events (MALE). This meta-analysis included 19 studies with 800,452 patients. Compared with angiography-guided EVT, IVUS-guided EVT significantly reduced the risk of binary restenosis (risk ratio [RR] 0.63, 95% confidence interval [CI] 0.43 to 0.91, p = 0.02). It also reduced the risk of reintervention (RR 0.59, 95% CI 0.39 to 0.90, p = 0.01), major amputation (RR 0.85, 95% CI 0.74 to 0.98, p = 0.02), death or amputation (RR 0.72, 95% CI 0.56 to 0.91, p = 0.007), and MALE (RR 0.52, 95% CI 0.28 to 0.94, p = 0.03). Subgroup analysis for femoropopliteal disease revealed consistent benefits of IVUS guidance regarding binary restenosis (RR 0.63, 95% CI 0.42 to 0.94, p = 0.03), reintervention (RR 0.51, 95% CI 0.33 to 0.80, p = 0.003), major amputation (RR 0.85, 95% CI 0.73 to 0.99, p = 0.04), death or amputation (RR 0.68, 95% CI 0.51 to 0.90, p = 0.007), and MALE (RR 0.51, 95% CI 0.27 to 0.96, p = 0.04). The sensitivity analysis of studies using drug-coated devices also showed the consistent benefit of IVUS guidance regarding binary restenosis. In conclusion, compared with angiography, IVUS-guided EVT provided improved clinical outcomes in terms of binary restenosis, reintervention, major amputation, death or amputation, and MALE in lower extremity artery disease, including femoropopliteal disease.

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来源期刊

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.