TY - JOUR
T1 - Comparison of different guidance strategies to percutaneous coronary intervention: A network meta-analysis of randomized clinical trials
AU - Mandurino-Mirizzi, Alessandro
AU - Munafò, Andrea Raffaele
AU - Rizzo, Francesco
AU - Raone, Luca
AU - Germinal, Rancesco
AU - Montalto, Claudio
AU - Mussardo, Marco
AU - Vergallo, Rocco
AU - Fischetti, Dionigi
AU - Godino, Cosmo
AU - Colonna, Giuseppe
AU - Oreglia, Jacopo
AU - Burzotta, Francesco
AU - Crimi, Gabriele
AU - Porto, Italo
PY - 2024
Y1 - 2024
N2 - Background: The results of randomized clinical trials comparing the outcomes of different strategies for driving PCI are mixed, and it remains unclear which technique for driving PCI offers the greatest benefit. The aim of the study was to compare the clinical efficacy of different techniques to guide percutaneous coronary intervention (PCI). Methods: We search major electronic databases for randomized clinical trials evaluating clinical outcomes of PCI with stent implantation guided by coronary angiography (CA), fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The primary outcome was cardiac death. Results: The results from 39 randomized trials (29,614 patients) were included in the network meta-analyses. Compared with CA, the use of OCT (RR: 0.33, 95 % CI: 0.19–0.54), IVUS (RR: 0.47, 95 % CI: 0.31–0.71) and FFR (RR: 0.61, 95 % CI: 0.38–0.97) were associated with reduced risk of cardiac death; there were no differences between OCT, IVUS and OCT was ranked as the best strategy. PCI guidance using OCT, FFR and IVUS was also associated with a reduction of myocardial infarction. The use of OCT or IVUS for PCI guidance was associated with a significant reduction in target lesion failure, target vessel revascularization, target lesion revascularization and stent thrombosis, compared with CA. OCT-guided PCI was associated with a significant reduction in all-cause death compared with CA-guided PCI and with a reduction in TLF compared with FFR- and iFR-guided PCI. Pooled estimates were mostly consistent across several sensitivity analyses. Conclusions: Compared with angiography-guided PCI, both an intravascular imaging-guided strategy and a physiology-guided strategy are associated with better clinical outcomes.
AB - Background: The results of randomized clinical trials comparing the outcomes of different strategies for driving PCI are mixed, and it remains unclear which technique for driving PCI offers the greatest benefit. The aim of the study was to compare the clinical efficacy of different techniques to guide percutaneous coronary intervention (PCI). Methods: We search major electronic databases for randomized clinical trials evaluating clinical outcomes of PCI with stent implantation guided by coronary angiography (CA), fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The primary outcome was cardiac death. Results: The results from 39 randomized trials (29,614 patients) were included in the network meta-analyses. Compared with CA, the use of OCT (RR: 0.33, 95 % CI: 0.19–0.54), IVUS (RR: 0.47, 95 % CI: 0.31–0.71) and FFR (RR: 0.61, 95 % CI: 0.38–0.97) were associated with reduced risk of cardiac death; there were no differences between OCT, IVUS and OCT was ranked as the best strategy. PCI guidance using OCT, FFR and IVUS was also associated with a reduction of myocardial infarction. The use of OCT or IVUS for PCI guidance was associated with a significant reduction in target lesion failure, target vessel revascularization, target lesion revascularization and stent thrombosis, compared with CA. OCT-guided PCI was associated with a significant reduction in all-cause death compared with CA-guided PCI and with a reduction in TLF compared with FFR- and iFR-guided PCI. Pooled estimates were mostly consistent across several sensitivity analyses. Conclusions: Compared with angiography-guided PCI, both an intravascular imaging-guided strategy and a physiology-guided strategy are associated with better clinical outcomes.
KW - Fractional flow reserve
KW - Instantaneous wave-free ratio
KW - Percutaneous coronary intervention
KW - Optical coherence tomography
KW - Intravascular ultrasound
KW - Fractional flow reserve
KW - Instantaneous wave-free ratio
KW - Percutaneous coronary intervention
KW - Optical coherence tomography
KW - Intravascular ultrasound
UR - http://hdl.handle.net/10807/303842
U2 - 10.1016/j.ijcard.2024.132936
DO - 10.1016/j.ijcard.2024.132936
M3 - Article
SN - 0167-5273
VL - 422
SP - N/A-N/A
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -