Cardiology
integrating data from the ILUMIEN IV and OCTOBER trials with prior studies, to examine the effects of intravascular imaging guidance versus angiography guidance. The analysis compared: 1) the overall effects of intravascular imaging (IVUS and OCT) in improving outcomes of the PCI procedure versus angiography; 2) IVUS versus angiography; 3) OCT versus angiography; and 4) IVUS versus OCT. The analysis incorporated 20 randomised
trials of intravascular imaging-guided PCI compared with angiography-guided PCI in 12,428 patients with chronic and acute coronary syndromes. Of those, 7,038 were randomly allocated to
intravascular imaging guidance (including 3,120 patients randomised to IVUS guidance, 2,826 patients randomised to OCT guidance, and 1,092 patients randomised to IVUS or OCT guidance), and 5,390 patients were randomly allocated to angiography guidance. Patients were followed for between 6 months and 5 years. The primary endpoint was target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or target lesion revascularisation. Secondary endpoints included cardiac death, target vessel myocardial infarction, target lesion revascularisation, and stent thrombosis, as well as all-cause death, all myocardial infarction and target vessel revascularisation. Intravascular imaging (IVUS or OCT) guidance of PCI resulted in reductions in the primary composite outcome of target lesion failure by 31% compared with angiography guidance of PCI. Regarding secondary outcomes,
intravascular imaging guidance of PCI resulted in reductions in cardiac death by 46%, target vessel myocardial infarction by 20%, target lesion revascularisation by 29%, and stent thrombosis by 52% compared with angiography guidance of PCI. There were also statistically significant
reductions in all-cause death, all myocardial infarction and target vessel revascularisation with intravascular imaging guidance of PCI. The outcomes were similar for OCT-guided PCI and IVUS-guided PCI when compared individually against angiography and when compared to each other. Principal investigator Dr. Gregg Stone of
Icahn School of Medicine at Mount Sinai, New York, US, said: “The results of this network meta-analysis emphasise the importance of physicians using intravascular imaging with either OCT or IVUS to optimise stent outcomes and improve the long-term prognosis of their patients.”
Press ad_Version
2_120x168mm_B_AW.indd 1 March 2024 I
www.clinicalservicesjournal.com 61 09/02/2024 09:27
Importance of iron therapy Other key papers, presented at ESC Congress, included a meta-analysis to establish the value of iron therapy. The analysis found that: “Iron- deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, intravenous ferric carboxymaltose (FCM) is associated with a reduced risk of the composite outcome of total cardiovascular hospitalisation and cardiovascular death through 52 weeks compared with placebo.”10 Iron deficiency is common in heart failure, with a prevalence of 30%–80%, and is associated with increased mortality and hospitalisation.11 Randomised controlled trials of intravenous
iron in iron-deficient patients with heart failure have shown improvements in symptoms, functional capacity and quality of life, but the effect on clinical events has been unclear.12,13
current meta-analysis evaluated the effects of FCM therapy on hospitalisations and mortality in iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction. The meta-analysis pooled individual
The
participant data from three randomised, placebo-controlled trials of FCM in adult patients with heart failure and iron deficiency with at least 52 weeks of follow up: CONFIRM- HF, AFFIRM-AHF and HEART-FID. There were two primary efficacy endpoints: 1) composite of total cardiovascular hospitalisations and cardiovascular death and 2) composite of total heart failure hospitalisations and cardiovascular death. Both endpoints were examined through 52 weeks of follow up. Key secondary endpoints included individual components of the composite endpoints.
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
