冠心病合并心房颤动PCI术后双联与三联抗栓治疗对比的Meta分析  

Meta-analysis of dual versus triple antithrombotic therapy in patients with coronary heart disease and atrial fibrillation after PCI

作　　者：张晓晴 李树仁[2] 牛绍乾 郝潇[2] Zhang Xiaoqing;Li Shuren;Niu Shaoqian;Hao Xiao(Graduate School of Hebei Medical University,Shijiazhuang 050017,China)

机构地区：[1]河北医科大学研究生院,石家庄050017 [2]河北省人民医院心内科,石家庄050000

出　　处：《中国循证心血管医学杂志》2021年第7期782-787,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的评估冠状动脉粥样硬化性心脏病(冠心病)合并心房颤动(房颤)经皮冠状动脉介入治疗(PCI)术后患者应用双联与三联抗栓治疗的有效性与安全性。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、Pub Med、Embase、Web of Science、Cochrane Library等数据库,筛选出符合标准的文献提取数据后进行Meta分析。将研究对象分为双联抗栓治疗(DAT组)与三联抗栓治疗(TAT组),研究终点包括全因死亡,心血管死亡,不良心脑血管事件,心肌梗死(MI),支架血栓(ST),卒中等有效性及主要出血事件等安全性指标。结果共纳入20篇文献,包括17 203例冠心病合并房颤PCI术后患者,其中DAT组8981例,TAT组8222例。Meta分析表明,冠心病合并房颤PCI术后患者应用DAT与TAT相比主要出血事件发生率降低(RR=0.73,95%CI:0.62~0.87,P=0.0003),全因死亡、心血管死亡、不良心(脑)血管事件、MI、卒中等事件发生率均无明显差异,但ST发生率较高(RR=1.44,95%CI:1.02~2.04,P=0.04),差异有统计学意义。结论在冠心病合并房颤PCI术后患者应用DAT相比于TAT安全性较好,但在PCI早期,应谨慎选择DAT方案,尤其是在缺血事件复发及支架血栓高危的AF患者。Objective To evaluate the efficacy and safety of dual and triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI.Methods A literature search was conducted using the databases CNKI,WanFang,VIP,CBM,PubMed,Embase,Web of Science,Cochrane Library,and the literatures meeting the standards were selected for data extraction and meta analysis.The subjects were divided into DAT and TAT groups.The endpoints of the study included all-cause death,cardiovascular death,major adverse cardiovascular and cerebrovascular event,MI,ST,stroke and major bleeding events.Results A total of 20 articles were included,including 17,203 patients,including 8981 patients in DAT group and 8222 patients in TAT group.Meta analysis showed that compared with TAT,DAT is associated with a reduction in major bleeding events(RR=0.73,95%CI:0.62~0.87,P=0.0003),and there were no significant differences in all-cause death and cardiovascular death,major adverse cardiovascular and cerebrovascular event,MI and stroke,but with a significant increase of ST(RR=1.44,95%CI:1.02~2.04,P=0.04).Conclusion Compared with TAT,DAT is safer in patients with atrial fibrillation undergoing PCI,but DAT should be carefully applied in the early stage of PCI,especially in AF patients at high risk of recurrent ischemic events and stent thrombosis.

关 键 词：经皮冠状动脉介入治疗 心房颤动 双联抗栓治疗 三联抗栓治疗 

分 类 号：R541.75[医药卫生—心血管疾病]