Author + information
- Received August 15, 2017
- Accepted August 29, 2017
- Published online December 18, 2017.
- Sergio Buccheri, MD,
- Gabriele Franchina, MD,
- Sara Romano, MD,
- Sebastiano Puglisi, MD,
- Giuseppe Venuti, MD,
- Paolo D’Arrigo, MD,
- Bruno Francaviglia, MD,
- Matteo Scalia, RT,
- Antonio Condorelli, RT,
- Marco Barbanti, MD,
- Piera Capranzano, MD,
- Corrado Tamburino, MD, PhD and
- Davide Capodanno, MD, PhD∗ ()
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- ↵∗Address for correspondence:
Dr. Davide Capodanno, Division of Cardiology, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
Objectives The authors sought to explore the comparative clinical efficacy of different imaging modalities for guiding percutaneous coronary interventions (PCI).
Background Coronary angiography (CA) is the standard imaging modality for intraprocedural guidance of PCI. Intracoronary imaging techniques, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), can overcome some limitations of CA.
Methods Comprehensive hierarchical Bayesian network meta-analysis of randomized clinical trials and adjusted observational studies comparing clinical outcomes of PCI with stent implantation guided by CA, IVUS, or OCT.
Results A total of 31 studies encompassing 17,882 patients were included. Compared with CA guidance, the risks of all-cause death (odds ratio [OR]: 0.74; 95% credible interval [CrI]: 0.58 to 0.98), myocardial infarction (OR: 0.72; 95% CrI: 0.52 to 0.93), target lesion revascularization (OR: 0.74, 95% CrI: 0.58 to 0.90) and stent thrombosis (OR: 0.42; 95% CrI: 0.20 to 0.72) were significantly reduced by IVUS guidance. PCI guidance using either IVUS or OCT was associated with a significant reduction of major adverse cardiovascular events (OR: 0.79; 95% CrI: 0.67 to 0.91 and OR: 0.68; 95% CrI: 0.49 to 0.97, respectively) and cardiovascular death (OR: 0.47; 95% CrI: 0.32 to 0.66 and OR: 0.31; 95% CrI: 0.13 to 0.66, respectively). No differences in terms of comparative clinical efficacy were found between IVUS and OCT for all the investigated outcomes. Pooled estimates were consistent across several sensitivity analyses. However, the treatment effect of IVUS on all-cause death was neutralized in the analysis restricted to randomized clinical trials (OR: 1.03; 95% CrI: 0.41 to 2.14).
Conclusions Compared with CA, the use of intravascular imaging techniques for PCI guidance reduces the risk of cardiovascular death and adverse events.
- clinical outcomes
- coronary angiography
- intravascular ultrasound
- optical coherence tomography
- percutaneous coronary intervention
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 15, 2017.
- Accepted August 29, 2017.
- 2017 American College of Cardiology Foundation
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