Akshay Machanahalli Balakrishna, Dua Noor Butt, Alexander G Hall, Danielle B Dilsaver, Elissa S Altin, Srihari S Naidu, Jennifer A Rymer, Andrew M Goldsweig
{"title":"血管内成像对急性心肌梗死经皮冠状动脉介入治疗结果的影响:一项系统回顾和荟萃分析。","authors":"Akshay Machanahalli Balakrishna, Dua Noor Butt, Alexander G Hall, Danielle B Dilsaver, Elissa S Altin, Srihari S Naidu, Jennifer A Rymer, Andrew M Goldsweig","doi":"10.1097/MCA.0000000000001553","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intravascular imaging (IVI) facilitates optimal outcomes in percutaneous coronary intervention (PCI). Focused data on the impact of IVI on outcomes of PCI in acute myocardial infarction (AMI), in particular, are scarce.</p><p><strong>Methods: </strong>A systematic search of the PubMed, EMBASE, Medline, and Cochrane databases was conducted from their inception to 1 December 2024 for studies comparing IVI to coronary angiography alone to guide PCI in AMI. Outcomes of interest included all-cause mortality (primary), cardiac mortality, major adverse cardiovascular events (MACE), recurrent myocardial infarction, target vessel revascularization (TVR), stent thrombosis, and target lesion revascularization (TLR). Random effects models were used to calculate relative risks (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Fourteen studies (43 547 patients) met inclusion criteria; nine studies reported all-cause mortality. Among patients with AMI, compared with coronary angiography alone, patients with IVI-guided PCI had lower all-cause mortality (RR: 0.76, 95% CI: 0.64-0.89; P < 0.01). IVI had less cardiac death (RR: 0.71, 95% CI: 0.59-0.86; P < 0.01), MACE (RR: 0.85, 95% CI: 0.77-0.94; P < 0.01), recurrent MI (RR: 0.84, 95% CI: 0.71-99; P = 0.04), TVR (RR: 0.79, 95% CI: 0.70-0.89; P < 0.01), and stent thrombosis (RR: 0.69, 95% CI: 0.53-0.90; P = 0.01). TLR was not significantly different between IVI and coronary angiography alone.</p><p><strong>Conclusion: </strong>Among patients with AMI, IVI-guided PCI is associated with improved clinical outcomes compared with coronary angiography alone. Further high-quality randomized trials are needed to clarify the magnitude of benefit.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The impact of intravascular imaging on percutaneous coronary intervention outcomes in acute myocardial infarction: a systematic review and meta-analysis.\",\"authors\":\"Akshay Machanahalli Balakrishna, Dua Noor Butt, Alexander G Hall, Danielle B Dilsaver, Elissa S Altin, Srihari S Naidu, Jennifer A Rymer, Andrew M Goldsweig\",\"doi\":\"10.1097/MCA.0000000000001553\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intravascular imaging (IVI) facilitates optimal outcomes in percutaneous coronary intervention (PCI). Focused data on the impact of IVI on outcomes of PCI in acute myocardial infarction (AMI), in particular, are scarce.</p><p><strong>Methods: </strong>A systematic search of the PubMed, EMBASE, Medline, and Cochrane databases was conducted from their inception to 1 December 2024 for studies comparing IVI to coronary angiography alone to guide PCI in AMI. Outcomes of interest included all-cause mortality (primary), cardiac mortality, major adverse cardiovascular events (MACE), recurrent myocardial infarction, target vessel revascularization (TVR), stent thrombosis, and target lesion revascularization (TLR). Random effects models were used to calculate relative risks (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Fourteen studies (43 547 patients) met inclusion criteria; nine studies reported all-cause mortality. Among patients with AMI, compared with coronary angiography alone, patients with IVI-guided PCI had lower all-cause mortality (RR: 0.76, 95% CI: 0.64-0.89; P < 0.01). IVI had less cardiac death (RR: 0.71, 95% CI: 0.59-0.86; P < 0.01), MACE (RR: 0.85, 95% CI: 0.77-0.94; P < 0.01), recurrent MI (RR: 0.84, 95% CI: 0.71-99; P = 0.04), TVR (RR: 0.79, 95% CI: 0.70-0.89; P < 0.01), and stent thrombosis (RR: 0.69, 95% CI: 0.53-0.90; P = 0.01). TLR was not significantly different between IVI and coronary angiography alone.</p><p><strong>Conclusion: </strong>Among patients with AMI, IVI-guided PCI is associated with improved clinical outcomes compared with coronary angiography alone. Further high-quality randomized trials are needed to clarify the magnitude of benefit.</p>\",\"PeriodicalId\":10702,\"journal\":{\"name\":\"Coronary artery disease\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Coronary artery disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MCA.0000000000001553\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Coronary artery disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCA.0000000000001553","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
The impact of intravascular imaging on percutaneous coronary intervention outcomes in acute myocardial infarction: a systematic review and meta-analysis.
Background: Intravascular imaging (IVI) facilitates optimal outcomes in percutaneous coronary intervention (PCI). Focused data on the impact of IVI on outcomes of PCI in acute myocardial infarction (AMI), in particular, are scarce.
Methods: A systematic search of the PubMed, EMBASE, Medline, and Cochrane databases was conducted from their inception to 1 December 2024 for studies comparing IVI to coronary angiography alone to guide PCI in AMI. Outcomes of interest included all-cause mortality (primary), cardiac mortality, major adverse cardiovascular events (MACE), recurrent myocardial infarction, target vessel revascularization (TVR), stent thrombosis, and target lesion revascularization (TLR). Random effects models were used to calculate relative risks (RRs) with 95% confidence intervals (CIs).
Results: Fourteen studies (43 547 patients) met inclusion criteria; nine studies reported all-cause mortality. Among patients with AMI, compared with coronary angiography alone, patients with IVI-guided PCI had lower all-cause mortality (RR: 0.76, 95% CI: 0.64-0.89; P < 0.01). IVI had less cardiac death (RR: 0.71, 95% CI: 0.59-0.86; P < 0.01), MACE (RR: 0.85, 95% CI: 0.77-0.94; P < 0.01), recurrent MI (RR: 0.84, 95% CI: 0.71-99; P = 0.04), TVR (RR: 0.79, 95% CI: 0.70-0.89; P < 0.01), and stent thrombosis (RR: 0.69, 95% CI: 0.53-0.90; P = 0.01). TLR was not significantly different between IVI and coronary angiography alone.
Conclusion: Among patients with AMI, IVI-guided PCI is associated with improved clinical outcomes compared with coronary angiography alone. Further high-quality randomized trials are needed to clarify the magnitude of benefit.
期刊介绍:
Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management.
Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.