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目的 :系统评价血管内超声(intravascular ultrasound,IVUS)与冠脉造影(coronary angiography,CAG)指导药物洗脱支架(drug-eluting stent,DES)治疗冠心病的临床结局。方法:计算机检索Pub Med、Embase、Cochrane Library、Scopus和中国生物医学文献数据库,同时手动检索国内外相关心血管会议记录,收集IVUS与CAG指导DES治疗冠心病的临床研究。检索年限为2016年7月之前。采用STATA 12.0软件进行Meta分析。结果 :最终纳入23项符合要求的研究,共包含31 685例患者,其中3 192例来自7项随机对照研究。对此23项研究进行临床事件分析,整体结果表明IVUS指导DES治疗冠心病在死亡[比值比(OR):0.63,95%CI:0.55~0.73,P<0.001]、心肌梗死(OR:0.69,95%CI:0.58~0.82,P<0.001)、不良心脏事件(major adverse cardiac events,MACE)(OR:0.75,95%CI:0.69~0.82,P<0.001)、支架内血栓(OR:0.56,95%CI:0.43~0.73,P<0.001)、靶血管血运重建(OR:0.79,95%CI:0.68~0.93,P<0.001)、靶病变血运重建(OR:0.75,95%CI:0.62~0.91,P<0.001)方面优于CAG指导。结论:与CAG指导治疗冠心病相比,IVUS指导DES治疗冠心病能明显改善患者临床结局,有效减少死亡、心肌梗死、MACE、支架内血栓及再次血运重建。但IVUS指导DES治疗更适用于哪些患者群体及病变类型仍有待更多大型随机对照研究进一步验证。
OBJECTIVE: To systematically evaluate the clinical outcomes of intravascular ultrasound (IVUS) and coronary angiography (CAG) -related drug-eluting stent (DES) in the treatment of coronary heart disease. Methods: Pub Med, Embase, Cochrane Library, Scopus and Chinese Biomedical Literature Database were searched by computer. At the same time, the related cardiovascular records at home and abroad were manually searched and the clinical study of IVUS and CAG in guiding the treatment of coronary heart disease was collected. The search period is before July 2016. Meta-analysis was performed using STATA 12.0 software. RESULTS: Twenty-three eligible studies were eventually included, comprising 31,685 patients, of which 3,192 were from seven randomized controlled studies. The overall clinical outcome of these 23 studies showed that IVUS guided DES treatment of death at CHD [odds ratio (OR): 0.63, 95% CI: 0.55-0.73, P <.001], myocardial infarction (OR: (OR: 0.75, 95% CI: 0.69-0.82, P <0.001), stent thrombosis (OR: 0.56, (OR: 0.79, 95% CI: 0.68-0.93, P <0.001), target revascularization (OR: 0.75, 95% CI: 0.43-0.73, 0.62 ~ 0.91, P <0.001) than CAG guidance. CONCLUSION: Compared with CAG-guided treatment of coronary heart disease, IVUS-guided DES treatment of patients with coronary heart disease can significantly improve clinical outcomes and reduce death, myocardial infarction, MACE, stent thrombosis and revascularization. However, further studies of IVUS-guided DES treatment are more suitable for which patient groups and types of lesions are yet to be confirmed by more large randomized controlled studies.