Erosion Iii

Jia, Haibo; Dai, Jihong; He, Luping; Xu, Yiyue; Shi, Yongfeng; Zhao, Lei; Sun, Zhiqi; Liu, Yin; Weng, Ziqian; Feng, Xue; Zhang, Dirui; Chen, Tao; Zhang, Xiling; Li, Lulu; Xu, Yousheng; Wu, Yanqing; Yang, Yining; Wang, Chunmei; Li, Lang; Li, Jianping; Hou, Jingbo; Liu, Bin; Mintz, Gary S.; Yu, Bo

doi:10.1016/j.jcin.2022.01.298

Cited by 38 publications

(31 citation statements)

References 27 publications

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“…A total of 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 (Table 1). 3,4,6,19–47 The RENOVATE-COMPLEX-PCI trial (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention; 1639 patients) was deemed eligible only for the secondary pairwise meta-analyses because patients randomized to IVI could receive IVUS or OCT at the physician’s discretion. 48 No trial including ICA guidance systematically used quantitative coronary angiography and stent enhancement techniques for PCI optimization.…”

Section: Resultsmentioning

confidence: 99%

Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Giacoppo,

Laudani,

Occhipinti

et al. 2024

Circulation

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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, 0.92–1.58]). 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.

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Section: Resultsmentioning

confidence: 99%

Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Giacoppo,

Laudani,

Occhipinti

et al. 2024

Circulation

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“…Use of OCT-guidance during primary PCI in STEMI patients was associated with lower rates of stent implantation in EROSION III study. Majority of patients with plaque erosion did not undergo stent implantation and had similar event rates at 1 year as compared to the stented cohort [ 47 ]. These findings underline the importance of OCT imaging in ACS patients to identify the subgroup who may not require stenting.…”

Section: Discussionmentioning

confidence: 99%

Culprit lesion morphology on OCT in STEMI vs NSTEMI – a systematic review of 7526 patients

Mani¹,

Ojha²,

Sivadasanpillai³

et al. 2023

Journal of the Saudi Heart Association

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Background Patients with STEMI are postulated to have different culprit lesion morphology compared to NSTEMI. The use of OCT in ACS can help delineate lesion morphology. The aim of this systematic review was to analyze the available data on culprit plaque morphology in ACS patients. Methods The available literature was systematically screened for studies on culprit lesion morphology in ACS patients. Data was extracted from the selected studies and analyzed for baseline characteristics as well as culprit lesion morphology on OCT. Lesion characteristics between STEMI and NSTEMI groups were compared. Results A total of 32 studies were selected for the final analysis. The average age of the study population was 62.4 years. Majority of patients (66.6%) had STEMI on presentation. NSTEMI patients had a higher prevalence of diabetes compared to STEMI. Both STEMI and NSTEMI patients had similar prevalence of thin-cap fibroatheroma (44.9%). The mean fibrous cap thickness was 84.2 μm in the study. STEMI patients had higher prevalence of lipid plaques, macrophages and luminal thrombus as compared to NSTEMI patients. Plaque rupture was the predominant culprit lesion morphology in both STEMI and NSTEMI groups, with higher prevalence in STEMI patients. Plaque erosion was also more common in STEMI patients (34.4% vs 13.2%). Conclusion Plaque rupture is the predominat culprit lesion morphology in both STEMI and NSTEMI patients, despite having differences in baseline characteristics. Use of OCT to determine plaque morphology in ACS patients can help guide management strategy in select cases. [PROSPERO CRD42021249742].

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“…15 The purpose of intracoronary imaging should not be limited to guiding the revascularization strategy but also to minimize stent implantation in ACS patients. 16 Both CMD and vasospastic angina (VSA) are reported more frequently in women 17 and could be responsible for transient mismatch between blood supply and myocardial oxygen demands. Particularly, coronary artery spasm is a heterogeneous phenomenon that can also coexist with obstructive CAD with transient spasm provoking chest pain and persistent spasm leading to ACS.…”

Section: Imaging and Coronary Function Testingmentioning

confidence: 99%

“…OCT is able to detect the underlying mechanism in approximately 50% of cases of MINOCA and up to 85% using a multimodality approach combining OCT and cardiac magnetic resonance imaging 15 . The purpose of intracoronary imaging should not be limited to guiding the revascularization strategy but also to minimize stent implantation in ACS patients 16 …”

Section: Role Of Intracoronary Imaging and Coronary Function Testingmentioning

confidence: 99%

Reading 2023 ESC ACS guidelines between the lines: Gaps in evidence in women

Pompei,

van de Hoef,

den Ruijter

et al. 2023

Eur J Clin Investigation

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The terms sex and gender are often used interchangeably, yet 'sex' refers to biological and physiologic traits characterizing maleness and femaleness. 'Gender' refers to the roles and behaviours of men, women and the different gender diversities in between the two. Biological sex and sociocultural gender are often intimately connected and significant factors that impact cardiovascular health. In this editorial, we highlight the knowledge gaps on women in the 2023 ACS guidelines and mostly refer to sex differences, as we hypothesize that sex is one of the main drivers behind the pathophysiological differences in ACS between women and men.Cardiovascular disease (CVD) remains the leading cause of death worldwide among women accounting for 8.9 million deaths in 2019. 1,2 The European Society of Cardiology (ESC) recently published the 2023 guidelines on the management of acute coronary syndromes (ACS). For the first time, the task force members grouped unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) under a single spectrum of ACS taking into account clinical presentation, ECG and diagnostic work-up. 3 Guideline recommendations are based on evidence generated from randomized controlled trials (RCTs) and metaanalyses. Given women represent approximately 20%-30% of patients in RCTs of acute coronary syndromes, the recommendations are based on evidence from studies with majority representation of male patients.

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Erosion Iii

Cited by 38 publications

References 27 publications

Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Culprit lesion morphology on OCT in STEMI vs NSTEMI – a systematic review of 7526 patients

Reading 2023 ESC ACS guidelines between the lines: Gaps in evidence in women

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