IVUS对比冠状动脉造影指导DES置入治疗左主干病变疗效的荟萃分析  

Efficacy of intravascular ultrasound versus coronary angiographic guided drug-eluting stent implantation in the treatment of left main coronary artery disease:a meta-analysis

作　　者：袁晓航 胡鑫[1] 方岩 蒋梦婷 韩燕 冯欢欢 高磊[1] Yuan Xiaohang;Hu Xin;Fang Yan;Jiang Mengting;Han Yan;Feng Huanhuan;Gao Lei(Department of Cardiovascular Medicine,Sixth Medical Center,Chinese People′s Liberation Army General Hospital,Beijing 100853,China;Medical School of Chinese People′s Liberation Army,Beijing 100853,China;Department of Emergency,First Medical Center,Chinese People′s Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第六医学中心心血管病医学部,北京100853 [2]解放军医学院,北京100853 [3]解放军总医院第一医学中心急诊科,北京100853

出　　处：《中华心血管病杂志》2023年第1期66-72,共7页Chinese Journal of Cardiology

基　　金：国家自然科学基金项目(81970443),首都临床特色应用研究项目(Z171100001017158)。

摘　　要：目的比较血管内超声(IVUS)与冠状动脉造影指导药物洗脱支架(DES)置入治疗冠状动脉左主干(LMCA)病变的疗效。方法在PubMed、Embase和Cochrane Library数据库中检索在2021年8月前发表的,比较IVUS与冠状动脉造影指导的DES置入治疗LMCA病变的随机对照试验(RCT)和观察性研究。分别收集纳入研究的基线数据、介入手术资料以及终点事件。主要终点为主要心血管不良事件(MACE),次要终点为全因死亡、心原性死亡、心肌梗死(MI)、靶病变血运重建(TLR)以及靶血管血运重建(TVR)。分别采用纽卡斯尔-渥太华量表(NOS)和Cochrane偏倚风险评估工具对纳入研究进行质量评价。结果最终纳入9篇研究,其中3篇RCT、6篇观察性研究,共5527例LMCA病变患者。6项观察性研究的NOS评分均≥6分,3篇RCT的总体偏倚风险较低。荟萃分析结果显示,与单纯冠状动脉造影指导组相比,IVUS指导组的MACE(OR=0.55,95%CI 0.47~0.66,P<0.001)、全因死亡(OR=0.56,95%CI 0.43~0.74,P<0.001)、心原性死亡(OR=0.43,95%CI 0.30~0.61,P<0.001)、MI(OR=0.64,95%CI 0.52~0.79,P<0.001)、TLR(OR=0.49,95%CI 0.28~0.86,P=0.013)及TVR(OR=0.77,95%CI 0.60~0.98,P=0.037)发生率更低。结论与血管造影指导相比,IVUS指导可降低LMCA病变DES置入术后的MACE、死亡、MI、TLR及TVR的发生率,建议临床在LMCA的PCI治疗时应用IVUS进行指导。Objective To compare the efficacy of intravascular ultrasound(IVUS)and coronary angiography guided drug eluting stent(DES)implantation for the treatment of left main coronary artery(LMCA)lesions.Methods Randomized controlled trials(RCT)and observational studies,which compared IVUS with coronary angiography guided DES implantation for the treatment of LMCA lesions published before August 2021 were searched in PubMed,Embase and Cochrane Library databases.Baseline data,interventional procedures and endpoint events of each study were collected.The primary endpoint was major cardiovascular adverse events(MACE),and the secondary endpoints were all-cause death,cardiac death,myocardial infarction(MI),target lesion revascularization(TLR)and target vessel revascularization(TVR).The Newcastle-Ottawa Scale(NOS)and the Cochrane Collaboration Risk of Bias tool were used to evaluate the quality of the included studies.Results Nine studies were included,including 3 RCT and 6 observational studies,with a total of 5527 cases of LMCA.All the 6 observational studies had NOS scores≥6,and the 3 RCT had a low risk of overall bias.The results of meta-analysis showed that compared with coronary angiography guided group,MACE rate(OR=0.55,95%CI 0.47-0.66,P<0.001),all-cause death(OR=0.56,95%CI 0.43-0.74,P<0.001),cardiac death(OR=0.43,95%CI 0.30-0.61,P<0.001),MI(OR=0.64,95%CI 0.52-0.79,P<0.001),TLR(OR=0.49,95%CI 0.28-0.86,P=0.013)and TVR(OR=0.77,95%CI 0.60-0.98,P=0.037)were all significantly lower in the IVUS guided group.Conclusions Compared with angiography guided,IVUS guided PCI with DES implantation in LMCA lesions could significantly reduce the risk of MACE,death,MI,TLR and TVR.IVUS is thus superior to coronary angiography for guiding PCI treatment among patients with LMCA.

关 键 词：药物洗脱支架 血管内超声 冠状动脉左主干病变 荟萃分析 

分 类 号：R543.3[医药卫生—心血管疾病]