摘要
目的系统评价药物涂层球囊(DCB)与新一代药物洗脱支架(DES)治疗冠脉支架内再狭窄(ISR)的安全性及有效性。方法检索Pub Med、Cochrane图书馆、Clinicaltrials.gov、万方数据库及中国知网,同时查阅心血管相关网站。检索时间为2008年1月至2018年2月,收集已公布的比较DCB与新一代DES治疗ISR的随机对照研究。根据Cochrane系统评价手册5.3评价文献质量并提取资料,运用Rev Man 5.3和STATA 13.0软件进行荟萃分析。结果最终纳入7项研究,共包含1 363例患者(DCB组722例,新一代DES组641例)。在最长临床随访中,与DES组相比,DCB组发生靶病变血运重建[相对危险度(RR):1.43,95%可信区间1.00~2.05,P=0.05]的风险显著升高,而主要不良心血管事件(RR=1.27,95%可信区间0.91~1.76,P=0.16)、心原性死亡(RR=1.21,95%可信区间0.53~2.73,P=0.65)、支架内血栓(RR=1.39,95%可信区间0.49~3.93,P=0.54)和心肌梗死(RR=0.96,95%可信区间0.53~1.75,P=0.89)的发生风险比较,差异均无统计学意义(P>0.05)。结论与DCB比较,新一代DES治疗ISR患者发生靶病变血运重建的风险显著降低,并不增加主要不良心血管事件、心肌梗死、支架内血栓和心原性死亡的发生风险。
Objective To systematically review the safety and efficacy of drug-coated balloon（ DCB） and new-generation drug-eluting stents（ DES） in the treatment of patients with coronary in-stent restenosis（ ISR）. Methods The literatures were searched in the Pub Med,Cochrane Library,Clinicaltrials. gov,CNKI,Wanfang databases,potential studies from the related websites were checked from January 2008 to February 2018. Randomized controlled trials comparing DCB and new-generation DES for ISR were enrolled and assessed by the Cochrane Collaboration tool. All statistical analyses were performed with Rev Man 5. 3 and STATA 13. 0. Results Seven eligible trials with a total of 1 363 patients（ 722 cases in the DCB group,and 641 cases in the new-generation DES group） were included in the meta-analysis. In the longest clinical follow-up,the risk of target lesion revascularization（ TLR） was significantly higher in patients treated with DCB than in those who treated with new-generation DES（ RR： 1. 43,95% CI： 1. 00-2. 05,P = 0. 05）. The risk of major adverse cardiac events（ RR： 1. 27,95% CI： 0. 91-1. 76,P = 0. 16）,cardiac death（ RR： 1. 21,95% CI： 0. 53-2. 73,P = 0. 65）,stent thrombosis（ RR： 1. 39,95% CI： 0. 49-3. 93,P = 0. 54） and myocardial infarction（ RR： 0. 96,95% CI： 0. 53-1. 75,P = 0. 89） had no statistically significant difference between the two groups（ P〉0. 05）. Conclusion Compared with DCB,new-generation of DES in the treatment of ISR patients can significantly reduce the risk of target lesion reascularization,which will not increase the incidence of major adverse cardiac events,myocardial infarction,stent thrombosis or cardiac death.
作者
蔡金赞
王新宇
朱永翔
陈青远
李谦
张瑶俊
CAI Jin-zan;WANG Xin-yn;ZHU Yong-xiang;CHEN Qing-yuan;LI Qian;ZHANG Yao-jun(Nanjing Medical University, Nanjing 210006, China)
出处
《临床军医杂志》
CAS
2018年第5期534-539,共6页
Clinical Journal of Medical Officers
基金
南京市医学科技发展资金资助(YKK15101)
江苏省青年医学人才(QNRC2016065)
江苏省六大人才高峰项目(WSN-212)
