药物涂层球囊与药物洗脱支架治疗冠状动脉小血管病变的Meta分析  

The comparison of drug-coated balloons and drug-eluting stents in the treatment of coronary small vessel disease:a meta-analysis

作　　者：齐苗苗 王琼英[1] 孙润民 田丽 余静[1] 白锋[1] Qi Miaomiao;Wang Qiongying;Sun Runmin;Tian Li;Yu Jing;Bai Feng(Department of Cardiology,Lanzhou University Second Hospital,Lanzhou 730030,China.)

机构地区：[1]兰州大学第二医院心内科,兰州730030

出　　处：《中国循证心血管医学杂志》2021年第5期527-531,540,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：甘肃省卫生行业项目(GSWSKY2018-19);甘肃省中医药管理局项目(GZK-2018-51);兰州大学第二医院“萃英科技创新计划”项目(CY2017MS-14;CY2018-BJ03)。

摘　　要：目的比较药物涂层球囊(DCB)和药物洗脱支架(DES)在冠状动脉(冠脉)小血管病变中的疗效和安全性。方法通过计算机检索PubMed、The Cochrane Library和Web of Science数据库,检索截止至2019年5月1日正式发表的文献。纳入比较冠脉小血管病变患者使用药物涂层球囊与药物洗脱支架治疗差异的研究。运用RevMan 5.2软件进行Meta分析。结果最终纳入7篇文献,包括2030例患者,随访时间为6~12个月,结果表明,与DES相比,DCB可显著降低术后再发心肌梗死的发生(OR=0.58,95%CI:0.35~0.97,P=0.04),且在术后管腔狭窄百分比中,DCB也优于DES(MD=6.96,95%CI:3.59~10.32,P<0.0001)。而在靶病变血运重建(OR=1.02,95%CI:0.65~1.59,P=0.93)、主要心血管不良事件(OR=1.01,95%CI:0.72~1.41,P=0.94)、全因死亡(OR=0.56,95%CI:0.25~1.23,P=0.15)、心源性死亡(OR=2.01,95%CI:0.87~4.65,P=0.10)、靶血管血运重建(OR=0.91,95%CI:0.56~1.47,P=0.70)的发生方面,两种策略无显著差异。结论DCB在治疗冠脉小血管病变中不劣于DES,在再发心肌梗死及术后管腔狭窄程度方面优于DES。Objective To compare the efficiency and safety of drug-coated balloons(DCB)and drug-eluting stents(DES)in coronary small vessel disease.Methods PubMed,The Cochrane Library,and Web of Science databases were searched.The references published up to May 1,2019 were sought for.Studies comparing the drug-coated balloons with the drug-eluting stents strategy in patients with coronary small vessel disease(reference diameter<3 mm)were included.Data were analyzed using the statistical software RevMan 5.2.Results Seven trials were included,including 2030 patients,and the follow-up time was 6~12 months.The results showed that compared with DES,DCB can significantly reduce the incidence of myocardial infarction(OR=0.58,95%CI:0.35~0.97,P=0.04),and in the percentage of diameter stenosis,DCB is also better than DES(MD=6.96,95%CI:3.59~10.32,P<0.0001).While there is no significant difference in target lesions revascularization(OR=1.02,95%CI:0.65~1.59,P=0.93),major cardiovascular adverse events(OR=1.01,95%CI:0.72~1.41,P=0.94),all~cause death(OR=0.56,95%CI:0.25~1.23,P=0.15),cardiac death(OR=2.01,95%CI:0.87~4.65,P=0.10)and target vessel revascularization(OR=0.91,95%CI:0.56~1.47,P=0.70).Conclusions DCB is not inferior to DES in the treatment of coronary small vessel disease.It is superior to DES in myocardial infarction and diameter stenosis.

关 键 词：冠状动脉小血管病变 经皮冠状动脉介入治疗 药物洗脱球囊 药物洗脱支架 

分 类 号：R816.2[医药卫生—放射医学]