Efficacy of intravascular ultrasound versus coronary angiographic guided drug-eluting stent implantation in the treatment of left main coronary artery disease: a meta-analysis.
10.3760/cma.j.cn112148-20221201-00953
- Author:
Xiao Hang YUAN
1
;
Xin HU
2
;
Yan FANG
1
;
Meng Ting JIANG
1
;
Yan HAN
1
;
Huan Huan FENG
3
;
Lei GAO
2
Author Information
1. 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.
2. Department of Cardiovascular Medicine, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
3. 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.
- Publication Type:Journal Article
- MeSH:
Humans;
Coronary Artery Disease/complications*;
Coronary Angiography;
Drug-Eluting Stents/adverse effects*;
Treatment Outcome;
Percutaneous Coronary Intervention/methods*;
Ultrasonography, Interventional/methods*;
Risk Factors;
Myocardial Infarction/etiology*
- From:
Chinese Journal of Cardiology
2023;51(1):66-72
- CountryChina
- Language:Chinese
-
Abstract:
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 5 527 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.
