生物可吸收支架与依维莫斯洗脱支架在经皮冠状动脉介入治疗中的安全性和有效性Meta分析  

Meta-analysis on the Safety and Efficacy of Absorb Bioresorbable Vascular Scaffold Versus Everolimus Eluting Stent for Percutaneous Coronary Intervention

作　　者：刘彧祺 李绍龙[2] 马磊[1] 李海瑛 张智斌[1] 杜国栋[1] 雷强 王苹苹[1] 相艳[1] 邵党国[1] LIU Yu-qi;LI Shao-long;MA Lei;LI Hai-ying;ZHANG Zhi-bin;DU Guo-dong;LEI Qiang;WANG Ping-ping;XIANG Yan;SHAO Dang-guo(School of Information Engineering and Automation, Kunming University of Science and Technology, Kunming（650500）, Yunnan, Chin)

机构地区：[1]昆明理工大学信息工程与自动化学院,云南省昆明市650500 [2]昆明医科大学附属延安医院心内科 [3]昆明医科大学附属延安医院设备科 [4]云南财经大学中华职业学院企业教学管理部

出　　处：《中国循环杂志》2018年第6期550-554,共5页Chinese Circulation Journal

基　　金：国家博士后科学基金(2016M592894XB);云南省科技厅面上项目(KKS0201703015)

摘　　要：目的:系统评价生物可吸收支架(BVS)与依维莫司洗脱支架(EES)在经皮冠状动脉介入治疗(PCI)中的安全性和有效性。方法:计算机检索Pub Med、MEDILINE、EMBASE、Cochrane library、知网、万方等数据库,检索时限从建库到2017-10。同时查阅会议摘要和相关网站,收集已公布随访数据的有关随机对照试验。根据改良Jadad量表评价文献质量并提取资料,运用Review Manager 5.3软件进行Meta分析。主要的有效性终点和安全性终点为靶病变失败和支架内血栓形成。结果:共纳入9篇随机对照研究,共包含6 721例患者,其中BVS组3 670例,EES组3 051例。随访时间为6~36个月。Meta分析结果:BVS组靶病变失败(RR=1.31,95%CI:1.08~1.58,P=0.005)、支架内血栓形成(RR=2.89,CI:1.85~4.53,P<0.0001)、缺血驱动靶病变血运重建(RR=1.44,95%CI:1.12~1.86,P=0.005)、靶血管心肌梗死(RR=1.74,95%CI:1.33~2.27,P<0.0001)及所有心肌梗死(RR=1.49,95%CI:1.16~1.91,P=0.002)均高于EES组;全因死亡(RR=0.87,95%CI:0.57~1.33,P=0.520),心原性死亡(RR=0.78,95%CI:0.54~1.11,P=0.160)及患者相关的复合终点(RR=1.10,95%CI:0.95~1.27,P=0.210),两组差异均无统计学意义。结论:在PCI中BVS与EES相比安全性和有效性较低。BVS的安全性和有效性仍然需要更长时间的、大量的临床研究来论证。Objectives： To systemically review the safety and efficacy of bioresorbable vascular scaffold（BVS） versus everolimus eluting stent（EES） for percutaneous coronary intervention（PCI）.Methods： The database searched includes Pub Med, Medline, MEDILINE, EMBASE, Cochrane library, CNKI and Wanfang. Database retrieval time was between database establishment time to October 2017. During the same time, authors accessed the conference summary and related websites to collect published randomized controlled trials of published data. To evaluate the quality of the literature according to the modified Jadad scale and extracted the data. Meta-analysis was performed using Review Manager 5.3 software.Results： Nine trials were included; 6 721 patients were randomized to receive BVS（n=3 670） or EES（n=3 051）. Time offollow-up was ranged from 6 to 36 months. Compared with metallic EES, risk of target lesion failure（RR=1.31, 95%CI： 1.08-1.58; P=0.005） and in-stent thrombosis（RR=2.89, 95%CI： 1.85-4.53; P〈0.0001）, ischemia-driven target lesion revascularization（RR=1.44,95 % CI：1.12-1.86, P=0.005）、target-vessel myocardial infarction（RR=1.74, 95 % CI：1.33-2.27, P〈0.0001） and all myocardial infarction（RR=1.49, 95% CI：1.16-1.91, P=0.002） were all significantly higher in BVS group than in EES group. There were no significant differences in all-cause death（RR=0.87, 95 % CI： 0.57-1.33, P=0.520）, cardiovascular mortality（RR=0.78, 95% CI： 0.54-1.11, P=0.160） and composite endpoints（RR=1.10, 95% CI： 0.95-1.27, P=0.210） between the two groups. Conclusions： Compared with metallic EES, the BVS appears to be associated with both lower efficacy and higher thrombotic risk during the observation period.

关 键 词：经皮冠状动脉介入治疗 生物可吸收支架 依维莫斯洗脱支架 META分析 

分 类 号：R54[医药卫生—心血管疾病]