Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention : systematic review and meta-analysis
© 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..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:383 |
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| Enthalten in: |
BMJ (Clinical research ed.) - 383(2023) vom: 16. Nov., Seite e077848 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Khan, Safi U [VerfasserIn] |
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| Anmerkungen: |
Date Completed 20.11.2023 Date Revised 24.11.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmj-2023-077848 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364647353 |
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| 100 | 1 | |a Khan, Safi U |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention |b systematic review and meta-analysis |
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| 500 | |a Date Revised 24.11.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 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. | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN: Systematic review and meta-analysis | ||
| 520 | |a DATA SOURCES: PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023433568 | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Agarwal, Siddharth |e verfasserin |4 aut | |
| 700 | 1 | |a Arshad, Hassaan B |e verfasserin |4 aut | |
| 700 | 1 | |a Akbar, Usman Ali |e verfasserin |4 aut | |
| 700 | 1 | |a Mamas, Mamas A |e verfasserin |4 aut | |
| 700 | 1 | |a Arora, Shilpkumar |e verfasserin |4 aut | |
| 700 | 1 | |a Baber, Usman |e verfasserin |4 aut | |
| 700 | 1 | |a Goel, Sachin S |e verfasserin |4 aut | |
| 700 | 1 | |a Kleiman, Neal S |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Alpesh R |e verfasserin |4 aut | |
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