新一代药物洗脱支架植入术后短期与长期双联抗血小板治疗的安全性及有效性的Meta分析  

Meta-analysis of safety and efficacy of short-term and long-term dual antiplatelet therapy after new generation drug-eluting stents implantation

作　　者：侯雪娜 耿巍[2] 赵琳 刘念 王盼 Hou Xuena;Geng Wei;Zhao Lin;Liu Nian;Wang Pan(Chengde Medical University,Chengde 067000,China;不详)

机构地区：[1]承德医学院,承德067000 [2]保定市第一中心医院心内科,保定071000 [3]河北医科大学第一医院全科医学科,石家庄050000

出　　处：《中国循证心血管医学杂志》2021年第3期280-285,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的评价新一代药物洗脱支架植入术后短期(≤6个月)与长期(≥12个月)双联抗血小板治疗的安全性及有效性。方法计算机检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库、中国知网、维普期刊数据库及万方数据库,收集有关新一代药物洗脱植入术后双联抗血小板疗程的随机对照试验,检索时间为从建库至2020年1月。结局指标包括:全因死亡率、心源性死亡率、非心源性死亡率、心肌梗死、确定或可能支架内血栓形成、卒中、靶血管血运重建、主要出血事件及总出血事件的发生率。结果共11篇随机对照试验纳入Meta分析,共19920例患者。与长期组相比,短期双联抗血小板治疗组降低了总出血事件发生率(RR=0.77,95%CI:0.63~0.96,P=0.02),在全因死亡率(RR=0.87,95%CI:0.71~1.08,P=0.20)、心源性死亡率(RR=0.87,95%CI:0.66~1.15,P=0.32)、非心源性死亡率(RR=0.88,95%CI:0.64~1.21,P=0.43)、心肌梗死(RR=1.24,95%CI:1.00~1.54,P=0.05)、确定或可能支架内血栓形成(RR=1.21,95%CI:0.83~1.77,P=0.32)、卒中(RR=0.90,95%CI:0.63~1.28,P=0.55)、靶血管血运重建(RR=1.21,95%CI:0.95~1.54,P=0.12)、主要出血事件(RR=0.77,95%CI:0.53~1.10,P=0.15)的发生率上两组无明显差别。结论新一代药物洗脱支架植入术后短期双抗治疗的安全性及有效性不劣于长期双抗治疗,短期双联抗血小板治疗降低了总出血事件的发生率,且未增加全因死亡率、心源性死亡率、非心源性死亡率、心肌梗死、确定或可能支架内血栓形成、卒中、靶血管血运重建、主要出血事件的发生率,由于研究局限性,需要更多高质量的研究加以验证。Objective We aimed to evaluate the safety and efficacy of short-term(≤6 months)and longterm(≥12 months)dual antiplatelet therapy(DAPT)after new generation drug-eluting stents(DES)implantation.Methods We searched PubMed,EMbase,The Cochrane Library,CBM,CNKI,VIP,Wanfang database from inception to Jan,2020 for randomised controlled trials(RCTs)comparing short term with long term DAPT.There are the primary endpoints:all-cause death,cardiac death,non-cardiac death,myocardial infarction,definite or probable stent thrombosis,stroke,target vessel revascularization,major bleeding event and all bleeding events.Results Eleven RCTs with a total number of 19920 patients were included in the meta-analysis.When compared with long term DAPT,short term DAPT was associated with a reduction in all bleeding events(RR=0.77,95%CI:0.63~0.96,P=0.02),whereas all-cause death(RR=0.87,95%CI:0.71~1.08,P=0.20),non-cardiac death(RR=0.88,95%CI:0.64~1.21,P=0.43),myocardial infarction(RR=1.24,95%CI:1.00~1.54,P=0.05),definite or probable stent thrombosis(RR=1.21,95%CI:0.83~1.77,P=0.32),stroke(RR=0.90,95%CI:0.63~1.28,P=0.55),target vessel revascularization(RR=1.21,95%CI:0.95~1.54,P=0.12),major bleeding event(RR=0.77,95%CI:0.53~1.10,P=0.15)were similar.Conclusions The safety and efficacy of short-term DAPT is non-inferior to long-term.Short term DAPT following new generation DES implantation results in a reduction of all bleeding events with no apparent increase in all-cause death,cardiac death,non-cardiac death,myocardial infarction,stent thrombosis,stroke,target vessel revascularization or major bleeding event.Due to the limitations of this study,the above results are needed to be validated by more high quality studies.

关 键 词：药物洗脱支架 经皮冠脉介入治疗 双联抗血小板治疗 随机对照试验 META分析 

分 类 号：R816.2[医药卫生—放射医学]