Andrea Zito, Francesco Burzotta, Cristina Aurigemma, Enrico Romagnoli, Lazzaro Paraggio, Francesco Fracassi, Mattia Lunardi, Luigi Cappannoli, Francesco Bianchini, Carlo Trani
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引用次数: 0
摘要
背景：血管内成像（IVI）指导经皮冠状动脉介入治疗（PCI）的有效性是当代的热点话题。冠状动脉分叉病变和未受保护的左主干病变患者的PCI提供了特定的挑战，理论上，IVI可能特别受益。目的：比较IVI与血管造影指导下PCI治疗左主干分叉及无保护病变的临床效果。方法：在PubMed和Cochrane中央对照试验登记册中检索比较IVI（血管内超声或光学相干断层扫描）与血管造影指导左主干分叉和无保护病变患者的PCI的随机临床试验（rct）。两名研究者独立提取研究数据。风险比（RRs）采用方差反加权随机效应模型计算，95% ci采用改进的Knapp-Hartung-Sidik-Jonkman方法计算。主要结局为靶血管衰竭（TVF）。结果：共纳入7项随机对照试验，分岔病变分析2494例，未保护左主干病变分析1107例。平均随访时间为12 ~ 36个月。与血管造影指导相比，IVI指导显著降低了分叉病变（RR 0.70, 95% CI 0.53 ~ 0.92）和未保护的左主干病变（RR 0.55, 95% CI 0.36 ~ 0.84）的TVF。在分叉病变PCI中，需要治疗的人数为27人，而在无保护的左主干PCI中需要治疗的人数为11人。结论：在分叉和未保护左主干病变行PCI的患者中，IVI引导与血管造影引导相比可显著降低TVF的风险。普洛斯彼罗注册号：CRD42024580321。
Intravascular imaging for percutaneous coronary intervention on bifurcation and unprotected left main lesions: a systematic review and meta-analysis.
Background: The efficacy of intravascular imaging (IVI) guidance for percutaneous coronary intervention (PCI) represents a contemporary hot topic. PCI in patients with bifurcation coronary lesions and unprotected left main lesions offers specific challenges that, theoretically, may particularly benefit from IVI.
Objective: To compare the clinical outcomes between IVI and angiography guidance for PCI in bifurcation and unprotected left main lesions.
Methods: Randomised clinical trials (RCTs) comparing IVI (with either intravascular ultrasound or optical coherence tomography) with angiography to guide PCI in patients with bifurcation and unprotected left main lesions were searched in PubMed and Cochrane Central Register of Controlled Trials. Two investigators independently extracted study data. Risk ratios (RRs) were calculated using the random-effects model with inverse variance weighting and the 95% CIs with the modified Knapp-Hartung-Sidik-Jonkman method. The primary outcome was target vessel failure (TVF).
Results: A total of seven RCTs were included, collecting data on 2494 patients in the analysis for bifurcation lesions and 1107 patients in the analysis for unprotected left main lesions. The mean follow-up duration ranged from 12 to 36 months. Compared with angiography guidance, IVI guidance significantly reduced TVF both in bifurcation lesions (RR 0.70, 95% CI 0.53 to 0.92) and unprotected left main lesions (RR 0.55, 95% CI 0.36 to 0.84). The number needed to treat to prevent one TVF with IVI was 27 in bifurcation lesions PCI and 11 in unprotected left main PCI.
Conclusion: In patients undergoing PCI on bifurcation and unprotected left main lesions, IVI guidance significantly reduces the risk of TVF compared with angiography guidance.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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