Intravascular ultrasound-guided percutaneous coronary intervention for patients with coronary bifurcation lesions: A systematic review and meta-analysis.
- 作者列表："Yang RR","Lv YH","Guo C","Li M","Zhang MB","Wang ZL","Meng Y
BACKGROUND AND OBJECTIVE:Intravascular ultrasound (IVUS) could take on a vital position when angiographic images are not clear enough to be precisely visualized or measured by computer-aided technology. This meta-analysis was designed to compare the benefits of IVUS-guided and angiography-guided percutaneous coronary intervention(PCI) strategies for improving clinical outcomes. METHODS:PubMed, Embase, Web of Science, and Cochrane Library were searched for articles published from inception to 13th October, 2019. A comparative study of IVUS-guided and angiography-guided PCI strategies for patients with coronary bifurcation lesions was retrieved. The early endpoint events (≤1 year) and the late endpoint events (>1 years) were determined according to the follow-up time. The former included cardiac death, target lesion or vessel revascularization, stent thrombus, and major adverse cardiac events, while the latter included cardiac death. Statistical software Review Manager Version 5.3 was performed for meta-analysis. RESULTS:Five studies involving7,830 patients with coronary bifurcation lesions were included in this meta-analysis, the incidence of major adverse cardiac events for IVUS-guided strategy in patients with coronary bifurcation lesions were lower than those of patients with angiography-guided strategy at the early follow-up(OR = 0.55, 95% CI 0.42 - 0.70, P < .0001).Meanwhile, cardiac death, target vessel or target lesion revascularization, stent thrombosis were not statistically significant(OR = 0.68, 95% CI 0.34 - 1.35, P = .27; OR = 0.78, 95% CI 0.59 - 1.05, P = .10; OR = 0.36, 95% CI 0.12-1.04, P = .06).However, significant differences in cardiac death between IVUS-guided and angiographic-guided strategies were observed in the late follow - up (OR = 0.36, 95% CI 0.23 - 0.57, P < .00001). CONCLUSION:The IVUS-guided PCI strategy was associated with more clinical benefits compared with angiography-guided PCI strategy in patients with coronary bifurcation lesions. These findings suggest that the IVUS-guided PCI strategy can be recommended as an optimization in this kind of patients.
背景和目的: 血管内超声 (IVUS) 在血管造影图像不够清晰，无法通过计算机辅助技术精确可视化或测量时，可能占据重要位置。本荟萃分析旨在比较IVUS引导和血管造影引导的经皮冠状动脉介入治疗 (PCI) 策略对改善临床结局的益处。 方法: 检索PubMed、Embase、Web of Science和Cochrane图书馆从创刊到2019发表的文章。检索了冠状动脉分叉病变患者IVUS引导和血管造影引导PCI策略的对比研究。根据随访时间确定早期终点事件 (≤ 1年) 和晚期终点事件 (>1年)。前者包括心源性死亡、靶病变或血管血运重建、支架血栓和主要不良心脏事件，而后者包括心源性死亡。统计软件Review Manager版本5.3进行荟萃分析。 结果: 共纳入5项研究7、830例冠状动脉分叉病变患者，冠状动脉分叉病变患者采用IVUS指导策略的主要不良心脏事件发生率在早期随访时低于血管造影指导策略的患者 (or = 0.55，95% CI 0.42-0.70，p <.0001)。同时，心源性死亡，靶血管或靶病变血运重建、支架内血栓形成无统计学意义 (or = 0.68，95% CI 0.34-1.35，p = 。27; Or = 0.78，95% CI 0.59-1.05，p = 。10; Or = 0.36，95% CI 0.12-1.04，p =.06)。然而，在后期随访中观察到IVUS引导和血管造影引导策略之间心脏死亡的显著差异(Or = 0.36，95% CI 0.23-0.57，p <.00001)。 结论: 在冠状动脉分叉病变患者中，IVUS引导下的PCI策略比血管造影引导下的PCI策略具有更多的临床获益。这些发现表明，IVUS指导的PCI策略可以被推荐为这类患者的优化策略。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.