Comparison of different guidance strategies to percutaneous coronary intervention: A network meta-analysis of randomized clinical trials

Alessandro Mandurino-Mirizzi, Andrea Raffaele Munafò, Francesco Rizzo, Luca Raone, Rancesco Germinal, Claudio Montalto, Marco Mussardo, Rocco Vergallo, Dionigi Fischetti, Cosmo Godino, Giuseppe Colonna, Jacopo Oreglia, Francesco Burzotta, Gabriele Crimi, Italo Porto

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

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.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaInternational Journal of Cardiology
Volume422
DOI
Stato di pubblicazionePubblicato - 2024

Keywords

  • Fractional flow reserve
  • Instantaneous wave-free ratio
  • Percutaneous coronary intervention
  • Optical coherence tomography
  • Intravascular ultrasound

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