Drug-eluting balloons versus drug-eluting stents for the management of in-stent restenosis: A meta-analysis of randomized and observational studies
Drug-eluting balloons versus drug-eluting stents for the management of in-stent restenosis: A meta-analysis of randomized and observational studies
复制标题
药物洗脱球囊与药物洗脱支架治疗支架内再狭窄：随机和观察性研究的荟萃分析
DOI：
10.1016/j.jjcc.2016.12.019
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发表时间：
2017
影响因子：
2.5
通讯作者：
Yunpeng Shang
中科院分区：
文献类型：
--
作者：
Yanwei Wang;Xinmin Lou;Xiaomin Xu;Jianhua Zhu;Yunpeng Shang
本研究的目的是评价药物洗脱球囊(DEB)和药物洗脱支架(DES)在支架内再狭窄(ISR)患者中的疗效。背景DES和DEB是经皮冠状动脉介入治疗(PCI)的有效策略，但对ISR病变的最佳处理仍然存在争议。方法通过电子数据库检索随机对照试验和观察性队列研究，报道在ISR患者中使用DEB和DES的临床疗效。结果5项随机对照试验和5项观察性队列研究符合纳入标准，DEB组有962名患者，DES组有908名患者。在MACE(OR1.01；95%CI：0.64~1.58；p=0.97；I2=10.0%)、全因死亡(OR 1.04；95%CI：0.54~1.98；p=0.91；I2=10.0%)、心血管死亡(OR 1.44；95%CI：0.57~3.65；p=0.44；I2=10.0%)、支架血栓形成(OR 0.61；95%CI：0.16~2.33；p=0.47)等主要临床结局方面，DEB组与DES组无显著差异。I2=0.0%)和心肌梗死(OR 1.02；95%CI：0.53~1.94；p=0.96；I2=0.0%)。DEB与靶病变血管重建率显著相关(OR 1.54；95%CI：1.10~2.15；p=0.01；I2=0.57%)。结论DEB治疗ISR的临床疗效与DES植入相当。
ObjectivesThe aim of this study was to evaluate the efficacy of drug-eluting balloons (DEB) with drug-eluting stents (DES) in patients with in-stent restenosis (ISR).BackgroundDES implantation and DEB were available strategies in percutaneous coronary intervention (PCI) for ISR, but the optimal management for ISR lesions remains controversial.MethodsElectronic databases were searched for randomized controlled trials and observational cohort studies which reported the clinical outcomes of using DEB comparing with DES implantation in patients with ISR. Clinical endpoints such as major adverse cardiovascular events (MACE), death, and myocardial infarction were assessed.ResultsFive randomized controlled trials and five observational cohort studies with 962 patients in the DEB group and 908 patients in the DES group met inclusion criteria. There was no significant difference between DEB and DES in major clinical outcomes, such as MACE (OR 1.01; 95% CI: 0.64–1.58;p= 0.97;I2= 0%), all-cause death (OR 1.04; 95% CI: 0.54–1.98;p= 0.91;I2= 0%), cardiovascular death (OR 1.44; 95% CI: 0.57–3.65;p= 0.44;I2= 0%), stent thrombosis (OR 0.61; 95% CI: 0.16–2.33;p= 0.47;I2= 0%), and myocardial infarction (OR 1.02; 95% CI: 0.53–1.94;p= 0.96;I2= 0%). DEB was associated with a significant increase in target lesion revascularization (OR 1.54; 95% CI: 1.10–2.15;p= 0.01;I2= 57%).ConclusionTreatment of ISR using DEB led to comparable clinical outcomes with DES implantation.