Cargando…
Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis
OBJECTIVE: To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed/Medline, Embas...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10652093/ https://www.ncbi.nlm.nih.gov/pubmed/37973170 http://dx.doi.org/10.1136/bmj-2023-077848 |
_version_ | 1785147670948478976 |
---|---|
author | Khan, Safi U Agarwal, Siddharth Arshad, Hassaan B Akbar, Usman Ali Mamas, Mamas A Arora, Shilpkumar Baber, Usman Goel, Sachin S Kleiman, Neal S Shah, Alpesh R |
author_facet | Khan, Safi U Agarwal, Siddharth Arshad, Hassaan B Akbar, Usman Ali Mamas, Mamas A Arora, Shilpkumar Baber, Usman Goel, Sachin S Kleiman, Neal S Shah, Alpesh R |
author_sort | Khan, Safi U |
collection | PubMed |
description | OBJECTIVE: To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. STUDY SELECTION: Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. MAIN OUTCOME MEASURES: Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. RESULTS: In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. CONCLUSIONS: Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023433568. |
format | Online Article Text |
id | pubmed-10652093 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-106520932023-11-16 Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis Khan, Safi U Agarwal, Siddharth Arshad, Hassaan B Akbar, Usman Ali Mamas, Mamas A Arora, Shilpkumar Baber, Usman Goel, Sachin S Kleiman, Neal S Shah, Alpesh R BMJ Research OBJECTIVE: To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. STUDY SELECTION: Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. MAIN OUTCOME MEASURES: Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. RESULTS: In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. CONCLUSIONS: Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023433568. BMJ Publishing Group Ltd. 2023-11-16 /pmc/articles/PMC10652093/ /pubmed/37973170 http://dx.doi.org/10.1136/bmj-2023-077848 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Research Khan, Safi U Agarwal, Siddharth Arshad, Hassaan B Akbar, Usman Ali Mamas, Mamas A Arora, Shilpkumar Baber, Usman Goel, Sachin S Kleiman, Neal S Shah, Alpesh R Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
title | Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
title_full | Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
title_fullStr | Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
title_full_unstemmed | Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
title_short | Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
title_sort | intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10652093/ https://www.ncbi.nlm.nih.gov/pubmed/37973170 http://dx.doi.org/10.1136/bmj-2023-077848 |
work_keys_str_mv | AT khansafiu intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT agarwalsiddharth intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT arshadhassaanb intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT akbarusmanali intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT mamasmamasa intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT arorashilpkumar intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT baberusman intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT goelsachins intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT kleimanneals intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis AT shahalpeshr intravascularimagingguidedversuscoronaryangiographyguidedpercutaneouscoronaryinterventionsystematicreviewandmetaanalysis |