BACKGROUND:Results from multiple randomized clinical trials comparing outcomes after intravascular ultrasound (IVUS)– and optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) with invasive coronary angiography (ICA)–guided PCI as well as a pivotal trial comparing the 2 intravascular imaging (IVI) techniques have provided mixed results.METHODS:Major electronic databases were searched to identify eligible trials evaluating at least 2 PCI guidance strategies among ICA, IVUS, and OCT. The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events. Frequentist random-effects network meta-analyses were conducted. The results were replicated by Bayesian random-effects models. Pairwise meta-analyses of the direct components, multiple sensitivity analyses, and pairwise meta-analyses IVI versus ICA were supplemented.RESULTS:The results from 24 randomized trials (15 489 patients: IVUS versus ICA, 46.4%, 7189 patients; OCT versus ICA, 32.1%, 4976 patients; OCT versus IVUS, 21.4%, 3324 patients) were included in the network meta-analyses. IVUS was associated with reduced target lesion revascularization compared with ICA (odds ratio [OR], 0.69 [95% CI, 0.54–0.87]), whereas no significant differences were observed between OCT and ICA (OR, 0.83 [95% CI, 0.63–1.09]) and OCT and IVUS (OR, 1.21 [95% CI, 0.88–1.66]). Myocardial infarction did not significantly differ between guidance strategies (IVUS versus ICA: OR, 0.91 [95% CI, 0.70–1.19]; OCT versus ICA: OR, 0.87 [95% CI, 0.68–1.11]; OCT versus IVUS: OR, 0.96 [95% CI, 0.69–1.33]). These results were consistent with the secondary outcomes of ischemia-driven target lesion revascularization, target vessel myocardial infarction, and target vessel revascularization, and sensitivity analyses generally did not reveal inconsistency. OCT was associated with a significant reduction of stent thrombosis compared with ICA (OR, 0.49 [95% CI, 0.26–0.92]) but only in the frequentist analysis. Similarly, the results in terms of survival between IVUS or OCT and ICA were uncertain across analyses. A total of 25 randomized trials (17 128 patients) were included in the pairwise meta-analyses IVI versus ICA where IVI guidance was associated with reduced target lesion revascularization, cardiac death, and stent thrombosis.CONCLUSIONS:IVI-guided PCI was associated with a reduction in ischemia-driven target lesion revascularization compared with ICA-guided PCI, with the difference most evident for IVUS. In contrast, no significant differences in myocardial infarction were observed between guidance strategies.

中文翻译：

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冠状动脉造影、血管内超声和光学相干断层扫描用于指导经皮冠状动脉介入治疗：系统评价和网络荟萃分析

背景：多项随机临床试验的结果比较了血管内超声 (IVUS) 和光学相干断层扫描 (OCT) 引导下的经皮冠状动脉介入治疗 (PCI) 与侵入性冠状动脉血管造影 (ICA) 引导下的 PCI 的结果，以及比较了一项关键试验的结果2种血管内成像（IVI）技术提供了不同的结果。方法：检索主要电子数据库以确定评估ICA、IVUS和OCT中至少2种PCI指导策略的合格试验。 2 个共同主要结局是靶病变血运重建和心肌梗死。次要结局包括缺血驱动的靶病变血运重建、靶血管心肌梗死、死亡、心源性死亡、靶血管血运重建、支架血栓形成和主要不良心脏事件。进行了频率随机效应网络荟萃分析。结果通过贝叶斯随机效应模型得到了重复。补充了直接成分的成对荟萃分析、多重敏感性分析以及 IVI 与 ICA 的成对荟萃分析。 结果：24 项随机试验的结果（15 489 名患者：IVUS 与 ICA，46.4%，7189 名患者；OCT 与 ICA ，32.1%，4976 名患者；OCT 与 IVUS，21.4%，3324 名患者）被纳入网络荟萃分析。与 ICA 相比，IVUS 与目标病变血运重建减少相关（比值比 [OR]，0.69 [95% CI，0.54–0.87]），而 OCT 和 ICA 之间没有观察到显着差异（OR，0.83 [95% CI，0.63]） –1.09]）以及 OCT 和 IVUS（OR，1.21 [95% CI，0.88–1.66]）。指导策略之间的心肌梗死没有显着差异（IVUS 与 ICA：OR，0.91 [95% CI，0.70-1.19]；OCT 与 ICA：OR，0.87 [95% CI，0.68-1.11]；OCT 与 IVUS：OR， 0.96 [95% CI，0.69–1.33]）。这些结果与缺血驱动的靶病变血运重建、靶血管心肌梗死和靶血管血运重建的次要结局一致，并且敏感性分析通常没有发现不一致。与 ICA 相比，OCT 与支架内血栓形成显着减少相关（OR，0.49 [95% CI，0.26-0.92]），但仅限于频率分析。同样，IVUS 或 OCT 与 ICA 之间的生存率结果在分析中也不确定。 IVI 与 ICA 的成对荟萃分析中纳入了总共 25 项随机试验（17 128 名患者），其中 IVI 指导与减少靶病变血运重建、心源性死亡和支架内血栓形成相关。结论：IVI 指导 PCI 与与 ICA 引导的 PCI 相比，缺血驱动的靶病灶血运重建减少，其中 IVUS 的差异最为明显。相比之下，不同指导策略之间的心肌梗塞没有观察到显着差异。