雷帕霉素洗脱支架与金属裸支架治疗冠心病慢性完全闭塞病变临床效果的Meta分析  

Meta-analysis on Clinical Effect in Treating Chronic Totally Occluded Lesion of Patients with Coronary Heart Disease between Sirolimus-eluting Stent and Bare-metal Stent

作　　者：钟辉[1] 黄裕玉 

机构地区：[1]陕西省宝鸡市中心医院急诊科,721008 [2]佛山市顺德区第一人民医院心血管内科

出　　处：《实用心脑肺血管病杂志》2015年第10期1-5,10,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：广东省医学科研资助项目(B2011310)

摘　　要：目的评价雷帕霉素洗脱支架(SES)与金属裸支架(BMS)治疗冠心病慢性完全闭塞(CTO)病变的临床效果。方法计算机联网检索Pub Med、Cochrane Central Register of Controlled Trials、中国知网(CNKI)等全文数据库,筛选2000—2014年公开发表的关于SES与BMS治疗冠心病CTO病变临床效果的随机对照试验(RCT),SES组置入SES,BMS组置入BMS。对文献质量进行严格评价后,对符合要求的RCT进行资料提取并采用Rev Man 5.0软件进行Meta分析。比较SES组和BMS组患者主要不良心血管事件(MACEs)发生率、全因死亡率、心肌梗死(MI)发生率、支架内血栓形成(IST)发生率、靶病变血运重建(TLR)发生率、靶血管血运重建(TVR)发生率。结果共纳入5项符合标准的RCT,纳入患者总数为1 001例,其中SES组为501例、BMS组为500例。Meta分析结果显示:两组患者全因死亡率〔RR=1.55,95%CI(0.68,3.54),P=0.30〕、MI发生率〔RR=0.63,95%CI(0.35,1.14),P=0.13〕、IST发生率〔RR=1.81,95%CI(0.61,5.34),P=0.28〕比较,差异无统计学意义。SES组患者MACEs发生率〔RR=0.31,95%CI(0.23,0.42),P<0.000 01〕、TLR发生率〔RR=0.16,95%CI(0.11,0.25),P<0.000 01〕、TVR发生率〔RR=0.28,95%CI(0.21,0.38),P<0.000 01〕低于BMS组。结论基于现有文献证据,采用SES治疗的冠心病CTO病变患者MACEs发生率、TLR发生率、TVR发生率低于采用BMS治疗者,但全因死亡率、MI发生率、IST发生率间无差异,SES可作为临床治疗冠心病CTO病变的首选。Objective To evaluate the clinical effect in treating chronic totally occluded lesion of patients with coronary heart disease between sirolimus-eluting stent（SES）and bare-metal stent（BMS）.Methods A research was carried on Pub Med,Cochrane Central Register of Controlled Trials and CNKI by computer,to screen publicly published RCTs about clinical effect in treating chronic totally occluded lesion of patients with coronary heart disease between SES and BMS from^2000 to 2014,thereinto patients of SES group received SES,patients of BMS group received BMS.The involved literatures were strictly evaluated,and related data was extracted,Rev Man 5.0 software was used to carry out the meta-analysis.Incidence of MACEs,all-cause mortality,incidence of myocardial infarction,incidence of intra-stent thrombosis（IST）,incidence of target lesion revascularization（TLR）and incidence of target vascular reconstruction（TVR）were compared between the two groups.Results A total of 5 RCTs were involved,including 1 001 patients（501 patients in SES group,500 patients in BMS group）.Meta-analysis showed that,no statistically significant differences of all-cause mortality 〔RR = 1.55,95% CI（0.68,3.54）,P = 0.30〕,incidence of myocardial infarction 〔RR = 0.63,95% CI（0.35,1.14）,P = 0.13〕,incidence of IST 〔RR = 1.81,95% CI（0.61,5.34）,P = 0.28〕 between the two groups; incidence of MACEs 〔RR = 0.31,95% CI（0.23,0.42）,P〈0.000 01〕,incidence of TLR 〔RR = 0.16,95% CI（0.11,0.25）,P〈0.000 01〕 and incidence of TVR 〔RR = 0.28,95% CI（0.21,0.38）,P〈0.000 01〕of SES group were statistically significantly lower than those of BMS group.Conclusion Based on now available literature evidences,the incidence of MACEs,incidence of TLR and incidence of TVR of patients with coronary heart disease complicated with chronic totally occluded lesion that treated by SES are significantly lower than those patients treated by BMS,but all-cause mortality,incidence of myocardial infarction and incidence of IST

关 键 词：冠心病 冠状动脉闭塞 西罗莫司 药物洗脱支架 金属裸支架 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]