Objective To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. Design Systematic review and meta-analysis. Data sources PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. Study selection Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. Main outcome measures Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. Results In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. Conclusions Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. Systematic review registration PROSPERO CRD42023433568. The statistical code and dataset are available from the corresponding author.

中文翻译：

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血管内成像引导与冠状动脉造影引导经皮冠状动脉介入治疗：系统评价和荟萃分析

目的 考虑冠状动脉疾病患者的基线风险，评估血管内成像引导与血管造影引导经皮冠状动脉介入治疗的绝对治疗效果。设计系统回顾和荟萃分析。数据来源 PubMed/Medline、Embase 和 Cochrane 图书馆数据库，截至 2023 年 8 月 31 日。 研究选择 比较血管内成像（血管内超声检查或光学相干断层扫描）引导与冠状动脉造影引导经皮冠状动脉介入治疗成人冠状动脉疾病的随机对照试验。主要结果指标 使用随机效应荟萃分析和 GRADE（建议、评估、制定和评估分级）来评估证据的确定性。数据包括每 1000 人的心源性死亡、心肌梗死、支架血栓形成、靶血管血运重建和靶病变血运重建的比率和绝对风险。假设不同心血管风险阈值的比率恒定，使用五年基线风险的 SYNTAX 风险类别估计绝对风险差异。结果 在 20 项随机对照试验（n=11 698）中，血管内成像引导的经皮冠状动脉介入治疗与心源性死亡（比率 0.53，95% 置信区间 0.39 至 0.72）、心肌梗死（0.81、0.68 至 0.97）风险降低相关。 ）、支架血栓形成（0.44、0.27至0.72）、靶血管血运重建（0.74、0.61至0.89）和靶病变血运重建（0.71、0.59至0.86），但并非全部导致死亡（0.81、0.64至1.02）。使用 SYNTAX 风险类别，高确定性证据表明，从低风险到高风险，血管内成像可能与心脏死亡人数减少 23 至 64 人、心肌梗塞事件减少 15 至 19 人、支架血栓事件减少 9 至 13 人、靶标减少 28 至 38 人相关血管血运重建事件减少，每 1000 人目标病变血运重建事件减少 35 至 48 次。结论 与冠状动脉造影引导下的经皮冠状动脉介入治疗相比，血管内成像引导下的经皮冠状动脉介入治疗可显着降低冠心病患者的心源性死亡和心血管结局。血管内成像引导经皮冠状动脉介入治疗的估计绝对效果显示出与基线风险成比例关系，这是由冠状动脉疾病的严重性和复杂性驱动的。系统审评注册PROSPERO CRD42023433568。统计代码和数据集可从通讯作者处获得。