生物可吸收支架与药物洗脱支架治疗冠心病Meta分析被引量：2

Biore sorbable stents and drug-eluting stents in treatment of coronary heart disease:a meta-analysis

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摘要目的系统评价Absorb生物可吸收支架(BVS)与新一代药物洗脱支架(DES)治疗冠心病的安全性与有效性。方法计算机检索Pub Med、EMBASE、Cochrane Library、EBSCO、Scopus与中国生物医学文献数据库,同时手动检索国内外相关心血管会议记录,纳入2010年1月至2017年4月关于Absorb BVS与新一代DES治疗冠心病的≥2年随访的临床研究。采用Rev Man 5.3软件进行Meta分析,比较Absorb BVS与新一代DES治疗冠心病的安全性与有效性。结果最终纳入9个临床研究,其中7个为随机对照研究,共6 673例患者(Absorb BVS组3 766例,DES组2 907例)。Absorb BVS组与DES组患者全因死亡、心源性死亡、患者相关的复合终点发生率比较,差异均无统计学意义(P>0.05);Absorb BVS组患者主要临床终点靶病变失败[比值比(OR)=1.38,95%可信区间(95%CI)为1.14~1.67,P<0.05]发生率显著高于DES组;Absorb BVS组患者次要临床终点所有心肌梗死(OR=1.63,95%CI为1.27~2.08,P<0.05),明确/极可能的支架内血栓(OR=3.06,95%CI为1.96~4.78,P<0.05),极晚期支架内血栓(OR=4.36,95%CI为1.72~11.07,P<0.05),靶病变再次血运重建(OR=1.41,95%CI为1.11~1.79,P<0.05)发生率显著高于DES组。结论 Absorb BVS治疗冠心病的长期安全性与有效性可能劣于新一代DES。 Objective To system evaluate the safety and efficacy of absorb bioresorbable vascular scaffold （BVS） and drug-eluting stents （DES） for coronary heart disease. Methods Using computer to retrieve PubMed, EMBASE, the Cochrane Library, EBSCO, Sco- pus and CBMdisc ; at the same time, manually retrieved relevant cardiovascular meeting records internal and international, clinical stud- ys which had 2 years of follow-up results about Absorb BVS and new generation DES for treatment of coronary heart disease （CHD） from January 2010 to April 2017 were selected. Using RevMan 5.3 software to perform meta analysis,to compare the safety and effica- cy of Absorb BVS and new generation DES for CHD. Results There were finally 9 clinical studies been selected,including 7 random- ized control trials with 6 673 patients（3 766 in Absorb BVS group and 2 907 in DES group）. There was no statistically significant difference between the two groups in all-cause death, cardiac death and the incidence of patient-oriented composite endpoints （ P 〉 0. 05 ）. In Absorb BVS group,the incidence of primary clinical endpoints target lesion failure rate（ OR = 1.38,95% CI： 1.14 - 1.67, P 〈 0. 05 ）, the secondary clinical endpoints all myocardial infarction （ OR = 1.63,95 % CI： 1.27 - 2.08, P 〈 0. 05 ） , definite/probable stent or scaffold thrombosis （ OR = 3.06,95% CI： 1.96 - 4. 78, P 〈 0. 05 ）, very late stent thrombosis （ OR = 4. 36,95% CI： 1.72 - 11.07, P 〈 0. 05 ）, and target lesion revascularization （ OR = 1.41,95 % CI： 1.11 - 1.79, P 〈 0. 05 ） were all significantly higher than those in DES group. Conclusion The long-term safety and efficacy of Absorb BVS is probably worse than those of DES for coronary heart disease.