不同冠状动脉介入治疗方式在冠心病高出血风险患者中应用的Meta分析  

Meta-analysis of the comparison of different coronary interventions in coronary heart disease patients with high bleeding risk

作　　者：张海福 张琴霞 张媛媛[2] 杨栋[2] 张邢炜[2] ZHANG Haifu;ZHANG Qinxia;ZHANG Yuanyuan;YANG Dong;ZHANG Xingwei(The First People􀆳s Hospital of Fuyang,Hangzhou,Zhejiang 311400,China;Department of Cardiology,the Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang 310015,China)

机构地区：[1]杭州市富阳区第一人民医院,浙江省杭州市311400 [2]杭州师范大学附属医院心血管内科,浙江省杭州市310015

出　　处：《中国动脉硬化杂志》2021年第9期799-806,共8页Chinese Journal of Arteriosclerosis

基　　金：浙江省自然科学基金青年基金项目(LQI8H020006);浙江省医药卫生科技项目(2020KY216)。

摘　　要：目的分析比较裸金属支架(BMS)、药物涂层球囊(DCB)及药物洗脱支架(DES)在冠心病高出血风险(HBR)患者中应用的有效性和安全性。方法检索国内外电子数据库,收集在冠心病高出血风险患者中应用DCB或DES对比BMS的临床随机对照试验数据,使用Revman 5.3软件进行Meta分析。本次研究的主要终点为DCB和DES对比BMS在冠心病高出血风险患者中应用后的靶病变血运重建率、再发心肌梗死率、心源性死亡率以及出血率,次要终点为间接比较应用DCB和DES的靶病变血运重建率、再发心肌梗死率、心源性死亡率以及出血率,用以对比三者的临床效果。结果在冠心病高出血风险患者中,DCB组和DES组对比BMS组,靶病变血运重建率较低(RD=-0.04,95%CI:-0.05~-0.03,P<0.05),心源性死亡率较低(RD=-0.02,95%CI:-0.04~-0.01,P<0.05),再发心肌梗死率也较低(RD=-0.03,95%CI:-0.05~0.01,P<0.01)。DCB组比DES组拥有更低的靶病变血运重建率(0%比5.5%,RR=0.06,95%CI:0.00~0.98,P=0.05)和再发心肌梗死率(0%比5.8%,RR=0.06,95%CI:0.00~0.93,P<0.05)。三者均采取极短的双联抗血小板治疗(DAPT)方案,在出血率上无显著差异。结论在冠心病高出血风险患者中,DCB和新一代DES联合短期的DAPT对比BMS拥有更高的有效性及安全性。Aim To compare the efficacy and safety of bare metal stent(BMS),drug-coated balloon(DCB)and drug-eluting stent(DES)in coronary heart disease patients with high bleeding risk(HBR).Methods Domestic and international electronic databases were searched to collect randomized controlled clinical trials of DCB or DES vs.BMS in coronary heart disease patients with HBR,Meta-analysis was performed using Revman 5.3 software.The primary endpoints of this study were to compare the target lesion revascularization(TLR)rate,recurrent myocardial infarction rate,cardiogenic mortality rate and bleeding rate of DCB and DES vs.BMS in coronary heart disease patients with HBR.The secondary endpoints were to indirectly compare the TLR rate,recurrent myocardial infarction rate,cardiogenic mortality rate and bleeding rate of DCB and DES,so as to compare the clinical effect of the three.Results In coronary heart disease patients with HBR,compared with BMS group,DCB group and DES group had lower TLR rate(RD=-0.04,95%CI:-0.05~0.03,P<0.05),lower cardiogenic mortality rate(RD=-0.02,95%CI:-0.04~-0.01,P<0.05),and lower recurrent myocardial infarction rate(RD=-0.03,95%CI:-0.05~0.01,P<0.01).Compared with DES group,DCB group had lower TLR rate(0%vs.5.5%,RR=0.06,95%CI:0.00~0.98,P=0.05)and recurrent myocardial infarction rate(0%vs.5.8%,RR=0.06,95%CI:0.00~0.93,P<0.05).Patients in the three groups were treated with very short dual antiplatelet therapy(DAPT)program,and there was no significant difference in bleeding rate among the three groups.Conclusion In coronary heart disease patients with HBR,DCB and new generation DES combined with short-term DAPT have higher efficacy and safety than BMS.

关 键 词：冠心病 高出血风险 药物涂层球囊 药物洗脱支架 裸金属支架 靶病变血运重建 

分 类 号：R5[医药卫生—内科学]