血管内成像,功能性或血管学导向冠状动脉干预的比较
Toshiki Kuno1, Yuko Kiyohara2, Akiko Maehara3
1Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
血管内成像引导的皮肤冠状动脉干预 (PCI) 在减少主要心血管不良事件方面优于血管学引导的PCI. 这一策略也被证明是最好的预防心血管死亡,心肌梗塞和支架血栓在ACS和非ACS患者.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 穿皮冠状动脉干预 (PCI) 的最佳指导策略仍在争论中,特别是将血管内成像和功能指导与传统血管学进行比较.
- 这些策略在患有和没有急性冠状动脉综合征 (ACS) 的患者的不同影响需要澄清.
研究的目的:
- 为了比较成像导向PCI和功能导向PCI与血管学导向PCI的临床结果.
- 确定最佳的PCI指导策略,以优化患者的治疗结果.
主要方法:
- 进行了32项随机对照试验的网络元分析,涉及22,684名患者.
- 搜索了相关的随机对照试验的文献数据库 (PubMed,EMBASE).
- 主要结局是主要的不良心血管事件 (MACE),包括心血管死亡,心肌梗塞 (MI) 和目标病变再血管化 (TLR).
主要成果:
- 与血管造影指导的PCI相比,血管内成像指导的PCI显著降低了MACE风险 (RR:0.72).
- 图像引导的PCI还降低了心血管死亡 (RR:0.56),心肌梗塞 (RR:0.81),支架血栓 (RR:0.48) 和TLR (RR:0.75) 的风险.
- 功能导向的PCI还显示,MACE和MI风险相比血管学降低. 在ACS和非ACS队列中,结果一致.
结论:
- 血管造影指导的PCI与血管内成像指导和功能指导的PCI相比,结果更差.
- 血管内成像指导PCI已经成为降低心血管事件风险的优越策略.
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