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How to guide PCI?: A network meta-analysis
Jun Pang1, Liwen Ye, Qingwei Chen
1Department of Geriatric Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) significantly reduces major adverse cardiovascular events (MACEs) compared to traditional coronary angiography (CA). IVUS-guided PCI offers improved outcomes for patients undergoing coronary interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Traditional coronary angiography (CA) is the standard for assessing coronary artery anatomy and guiding percutaneous coronary intervention (PCI).
- The efficacy of novel PCI guidance techniques in improving patient mortality, major adverse cardiovascular events (MACEs), and myocardial infarction requires evaluation.
Purpose of the Study:
- To compare the effectiveness of various PCI guidance techniques against traditional CA.
- To assess the impact of different guidance methods on patient mortality, MACEs, and myocardial infarction.
Main Methods:
- A comprehensive network meta-analysis was conducted.
- Searched multiple databases including MEDLINE, EMBASE, PubMed, and Web of Science for relevant randomized clinical trials (RCTs).
- The last search was performed on December 10, 2018.
Main Results:
- No significant difference in overall mortality was observed among the different PCI guidance groups.
- Intravascular ultrasound (IVUS)-guided PCI demonstrated superiority over CA in RCTs for reducing MACEs.
- No significant differences were found in myocardial infarction incidence across all groups.
Conclusions:
- Intravascular ultrasound (IVUS)-guided PCI is an effective strategy for reducing all-cause death and MACEs.
- IVUS guidance offers a significant advantage in managing patients undergoing PCI.
Background:
Traditional coronary angiography (CA) as a main technique has been used to determine the coronary artery anatomy and guide percutaneous coronary intervention (PCI). We mainly focused on whether the new techniques could improve the patients' mortality, major adverse cardiovascular events (MACEs), and myocardial infarction.
Methods:
For the network meta-analysis, we searched the trials of different PCI guidances from MEDLINE, Current Contents Connect, Google Scholar, EMBASE, Cochrane Library, PubMed, Science Direct, and Web of Science. The last search date was December 10, 2018.
Results:
The analyses of all results found that there was no significant difference in mortality among the groups. Randomized clinical trials (RCT) analysis showed that intravascular ultrasound (IVUS)-guided PCI was significantly superior to CA, fractional flow reserve, instantaneous wave-free ratio, optical coherence tomography. However, CA, fractional flow reserve, instantaneous wave-free ratio, and optical coherence tomography showed no difference in reducing mortality. The analyses of all results found that there was no significant difference in the incidence of MACEs among the groups. RCTs analysis showed that IVUS-guided PCI was significantly superior to CA, but there was no significant difference among the other groups. The analyses of all results or RCTs showed that there was no significant difference in myocardial infarction incidence among the groups.
Conclusion:
IVUS-guided PCI is an effective method to decrease all-cause death MACEs.
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