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. 2022 Jun 3:9:860189.
doi: 10.3389/fcvm.2022.860189. eCollection 2022.

Clinical Outcomes Following Hemodynamic Parameter or Intravascular Imaging-Guided Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents: An Updated Systematic Review and Bayesian Network Meta-Analysis of 28 Randomized Trials and 11,860 Patients

Meng-Jin Hu  1 , Jiang-Shan Tan  1 , Lu Yin  1 , Yan-Yan Zhao  1 , Xiao-Jin Gao  1 , Jin-Gang Yang  1 , Yue-Jin Yang  1
Affiliations

Clinical Outcomes Following Hemodynamic Parameter or Intravascular Imaging-Guided Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents: An Updated Systematic Review and Bayesian Network Meta-Analysis of 28 Randomized Trials and 11,860 Patients

Meng-Jin Hu et al. Front Cardiovasc Med. .

Abstract

Background: Coronary angiography (CAG) is the standard imaging modality for guiding percutaneous coronary interventions (PCI). Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and hemodynamic parameter like fractional flow reserve (FFR) can overcome some limitations of CAG.

Objective: We sought to explore the clinical outcomes of different PCI guidance modalities in the era of drug-eluting stent (DES).

Methods: A network meta-analysis of 28 randomized trials and 11,860 patients undergoing different modalities-guided PCI in the era of DES was performed. Odds ratio (OR) with 95% credible interval (CrI) were calculated.

Results: In comparison with CAG, IVUS was associated with a significant reduction in major adverse cardiovascular events (MACE, OR: 0.60; 95% CrI: 0.46-0.79), cardiovascular death (OR: 0.46; 95% CrI: 0.20-0.94), target vessel/lesion revascularization (TVR/TLR, OR: 0.55; 95% CrI: 0.41-0.74), and a trend toward decreased risk of stent thrombosis (OR: 0.44; 95% CrI: 0.17 to 1.00). FFR/quantitative flow ratio (QFR) could significantly reduce stroke compared with CAG, IVUS, and OCT/optical frequency domain imaging (OFDI). However, myocardial infarction (MI), all-cause death, stent thrombosis, and any revascularization presented similar risks for different PCI guidance modalities.

Conclusion: In the era of DES, IVUS led to lower risks of MACE than CAG, which was mainly due to lower risks of cardiovascular death and TVR/TLR. A trend toward decreased risk of stent thrombosis was also observed with IVUS. Hemodynamic parameter (FFR/QFR)-guided PCI could significantly reduce the stroke risk compared with CAG, IVUS, and OCT/OFDI.

Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021291442].

Keywords: coronary angiography; drug-eluting stent (DES); fractional flow reserve (FFR); intravascular ultrasound (IVUS); optical coherence tomography (OCT); percutaneous coronary interventions (MeSH: D062645).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA diagram for study inclusion. CAG, coronary angiography; FFR, fractional flow reserve; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OFDI, optical frequency domain imaging; QFR, quantitative flow ratio.
FIGURE 2
FIGURE 2
Comparisons of primary outcomes among guidance modalities included in the network meta-analysis. CAG, coronary angiography; FFR, fractional flow reserve; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OFDI, optical frequency domain imaging; QFR, quantitative flow ratio. (A) Major adverse cardiovascular events. (B) Cardiovascular death. (C) Myocardial infarction. (D) target vessel revascularization/target lesion revascularization.
FIGURE 3
FIGURE 3
Rank probability analysis for primary outcomes among guidance modalities included in the network meta-analysis. Rank 1 is the best while rank 4 is the worst. For example, for MACE (A), IVUS had the highest probability of ranking 1, CAG had the lowest probability of ranking 1. CAG, coronary angiography; FFR, fractional flow reserve; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OFDI, optical frequency domain imaging; QFR, quantitative flow ratio. (A) Major adverse cardiovascular events. (B) Cardiovascular death. (C) Myocardial infarction. (D) Target vessel revascularization/target lesion revascularization.
FIGURE 4
FIGURE 4
Comparisons of secondary outcomes among guidance modalities included in the network meta-analysis. CAG, coronary angiography; FFR, fractional flow reserve; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OFDI, optical frequency domain imaging; QFR, quantitative flow ratio. (A) All-cause death. (B) Stroke. (C) Stent thrombosis. (D) Any revascularization.
FIGURE 5
FIGURE 5
Rank probability analysis for secondary outcomes among guidance modalities included in the network meta-analysis. Rank 1 is the best while rank 4 is the worst. For example, for all-cause death (A), IVUS had the highest probability of ranking 1, CAG had the lowest probability of ranking 1. CAG, coronary angiography; FFR, fractional flow reserve; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OFDI, optical frequency domain imaging; QFR, quantitative flow ratio. (A) All-cause death. (B) Stroke. (C) Stent thrombosis. (D) Any revascularization.
FIGURE 6
FIGURE 6
Comparisons of cardiovascular death and target vessel/lesion revascularization in the network meta-analysis. CAG, coronary angiography; FFR, fractional flow reserve; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OFDI, optical frequency domain imaging; QFR, quantitative flow ratio; TVR/TLR, target vessel/lesion revascularization.
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