比较血管内超声与冠脉造影指导药物洗脱支架治疗冠心病的Meta分析

目的:系统评价血管内超声(intravascular ultrasound,IVUS)与冠脉造影(coronary angiography,CAG)指导药物洗脱支架(drug-eluting stent,DES)治疗冠心病的临床结局?方法:计算机检索PubMed?Embase?Cochrane Library?Scopus和中国生物医学文献数据库,同时手动检索国内外相关心血管会议记录,收集IVUS与CAG指导DES治疗冠心病的临床研究?检索年限为2016年7月之前?采用STATA 12.0软件进行Meta分析?结果:最终纳入23项符合要求的研究,共包含31 685例患者,其中3 192例来自7项随机对照研究?对此23项研究进行临床事件分析,整体结果表明IVUS指导DES治疗冠心病在死亡比值比(OR):0.63,95%CI:0.55~0.73,P < 0.001]?心肌梗死(OR:0.69,95%CI:0.58~0.82,P < 0.001)?不良心脏事件(major adverse cardiac events,MACE)(OR:0.75,95%CI:0.69~0.82,P < 0.001)?支架内血栓(OR:0.56,95%CI:0.43~0.73,P < 0.001)?靶血管血运重建(OR:0.79,95%CI:0.68~0.93,P < 0.001)?靶病变血运重建(OR:0.75,95%CI:0.62~0.91,P < 0.001)方面优于CAG指导?结论:与CAG指导治疗冠心病相比,IVUS指导DES治疗冠心病能明显改善患者临床结局,有效减少死亡?心肌梗死?MACE?支架内血栓及再次血运重建?但IVUS指导DES治疗更适用于哪些患者群体及病变类型仍有待更多大型随机对照研究进一步验证?

Meta-analysis of intravascular ultrasound versus coronary angiography guided drug-eluting stent implantation for treating patients with coronary artery disease

Objective:To systematically review the clinical outcomes of drug-eluting stents (DES) guided by intravascular ultrasound(IVUS) versus coronary angiography (CAG) for the patients with coronary artery disease (CAD). Methods:We searched relevant literatures in PubMed,Embase,Cochrane Library,Scopus and Chinese Biomedical Database from January in 2000 to July in 2016,meanwhile,collected published data and studies from cardiovascular congresses to compare IVUS- and CAG-guided DES implantation for CAD patients. Meta-analyses were conducted by STATA 12.0 software. Results:Twenty-three eligible studies with a total of 31 685 patients were enrolled,of whom 3 192 patients were from randomized controlled trials. In general,intervention with DES guided by IVUS was associated with significant improvements on death(OR:0.63,95% CI:0.55~0.73,P < 0.001),myocardial infarction(MI,OR:0.69,95%CI:0.58~0.82,P < 0.001),major adverse cardiac events(MACE,OR:0.75,95%CI:0.69~0.82,P < 0.001),stent thrombosis(OR:0.56,95%CI:0.43~0.73,P < 0.001),target vessel revascularization(TVR,OR:0.79,95%CI:0.68~0.93,P < 0.001),and target lesion revascularization(TLR,OR:0.75,95%CI:0.62~0.91,P < 0.001),when compared with CAG guidance. Conclusion:IVUS guidance was associated with significantly improved clinical outcomes,including death,MI,MACE,stent thrombosis and re-intervention,compared with CAG guidance in the treatment of patients with CAD. Appropriately powered randomized trials are warranted to verify the findings of this meta-analysis and determine which types of patients and lesions will be benefit more from IVUS guidance.