Intravascularultrasound-guided Percutaneous Coronary Intervention For Patients With Bifurcation Lesions A Systematic Review And Meta-analysis

Background and objective: Because coronary bifurcation crest and the severity of coronary bifurcation lesions cannot be accurately evaluated by coronary angiography,which may affect the outcome of percutaneous coronary intervention.Intravascular ultrasound can make up for its deficiency,and accurately evaluate the effect of coronary artery shape and length,plaque load and bifurcation lesions on revascularization,and reduce the occurrence of restenosis after percutaneous coronary intervention.However,whether percutaneous coronary intervention under the guidance of intravascular ultrasound is superior to coronary angiography in the treatment of coronary bifurcation lesions remains controversial.Therefore,this study assumes that the uses of intravascular ultrasound can optimize the effect of vascular interventional therapy in patients with bifurcation lesions,reduce the incidence of adverse cardiac events,and use meta-analysis to affirm it.Methods: PubMed,EMBASE,Web of Science,the Cochrane library and Chinese database were searched from inception to October 2019 comparing the study of percutaneous coronary intervention under the guidance of intravascular ultrasound and coronary angiography in patients with coronary bifurcation lesions.Early endpoint events and late endpoint events were distinguished by follow-up time for 1year.The early endpoint events were composed of cardiac death,stent thrombosis,target vessel or lesion revascularization,major adverse cardiac events;the late endpoint event only included cardiac death.Randomized controlled trials or/and observational studies were recruited to implement quality evaluation according to the inclusion and exclusion criteria.Analyses were performed by using the Review Manager Version 5.3.Results: Five observational studies involving 7,830 patients with coronary bifurcation lesions compared with the guidance of intravascular ultrasound andcoronary angiography were included in this meta-analysis,and the results showed that the incidence of the early major adverse cardiovascular events in coronary bifurcation lesions patients with intravascular ultrasound-guided was lower than that of patients with coronary angiography-guided [odds ratio(OR)=0.55,95% confidence interval(CI)0.42-0.70,P<0.0001];In addition,there were no statistically significant in the rate of cardiac death,target lesion or target vessel revascularization,stent thrombosis[OR=0.68,95% CI 0.34-1.35,P=0.27;OR=0.78,95% CI 0.59-1.05,P=0.10;OR=0.36,95% CI 0.12-1.04,P=0.06] between two groups.During the late follow-up,the incidence of cardiac death after revascularization in coronary bifurcation lesions patients with intravascular ultrasound-guided was lower than in patients with coronary angiography-guided [OR=0.36,95% CI 0.23-0.57,P<0.00001].The subgroup analysis showed that there was no statistically significant in the heterogeneity sources of the early major adverse cardiovascular events(P>0.05).Conclusion: Compared with the percutaneous coronary intervention guided by coronary angiography,intravascular ultrasound-guided percutaneous coronary intervention significantly reduced the occurrence of the early major adverse cardiovascular events and the late cardiac death in patients with coronary bifurcation lesions.It can be used as an optimal choice for treatment with coronary bifurcation lesions.However,the clinical effect of coronary bifurcation lesions patients with intravascular ultrasound-guided still needs to be further confirmed by multicenter,large scale,long term follow-up randomized controlled trials.