Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis
Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis
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DOI：
10.1002/ccd.27484
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发表时间：
2018-06-01
影响因子：
2.3
通讯作者：
Bernardo, Nelson L.
中科院分区：
文献类型：
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作者：
Koifman, Edward;Lipinski, Michael J.;Bernardo, Nelson L.
目的：在贝叶斯网络随机对照试验荟萃分析中比较治疗策略。背景外周动脉疾病(PAD)是一种常见的疾病，可采用不同的治疗策略。方法我们进行MEDLINE随机研究，比较至少2种治疗策略，包括搭桥手术、经皮腔内血管成形术(PTA)、支架、覆膜支架、药物洗脱支架(DES)和药物涂层球囊(DCB)，这些治疗策略包括搭桥手术、经皮腔内血管成形术(PTA)、支架、覆膜支架、药物涂层球囊(DCB)。建立混合治疗比较模型，直接和间接比较以优势比(OR，[95%可信区间])表示的再狭窄和靶病变血运重建(TLR)的策略。其中PTA最多，有1900例，其次是DCB(1,343例)、裸金属支架(941例)、覆膜支架(304例)、DES(236例)和搭桥术(92例)。平均年龄为689岁，%为男性，37%为糖尿病，55%为吸烟者。病变平均长度为77+/-44 mm，39%为完全闭塞。贝叶斯分层随机效应模型显示，所有治疗方法均显著优于PTA，或有优于PTA的趋势，DCB在再狭窄(OR=0.29，[0.17~0.47])和TLR(OR=0.31，[0.20~0.46])中的排名均较好。尽管如此，在存活或截肢方面，没有一种治疗方法显示出优势。结论近年来，股骨-延髓疾病的治疗有了显著的进步，有更高的通畅率和对TLR的自由。然而，这些治疗策略在减少截肢和总体存活率方面的效用仍然存在疑问。
ObjectivesWe sought to compare treatment strategies in a Bayesian network meta-analysis of randomized controlled trials.BackgroundPeripheral artery disease (PAD) is a prevalent morbidity that is treated with various strategies.MethodsWe performed a MEDLINE search for randomized studies comparing at least 2 treatment strategies, including bypass surgery, percutaneous transluminal angioplasty (PTA) balloons, stents, covered stents, drug-eluting stents (DES), and drug-coated balloons (DCB), in patients with native femoro-popliteal disease. Mixed treatment comparison model generation was performed to directly and indirectly compare the strategies in terms of restenosis and target lesion revascularization (TLR) presented as odds ratios (OR, [95% credible intervals]).ResultsTwenty-nine studies with 4,820 patients were included in the present study. PTA was the largest group with 1,900 patients, followed by DCB (n=1,343), bare metal stents (n=941), covered stents (n=304), DES (n=236), and bypass (n=92). Mean age was 689 years, 64% were male, 37% diabetic, and 55% smokers. Mean lesion length was 77 +/- 44 mm, and 39% were total occlusions. Bayesian hierarchical random-effects model demonstrated all treatments were significantly better than, or had a trend toward superiority over, PTA, with DCB ranking well in both restenosis (OR=0.29, [0.17-0.47]) and TLR (OR=0.31, [0.20-0.46]). Nonetheless, none of the therapies showed superiority in terms of survival or amputations.ConclusionTreatment of femoro-popliteal disease has significantly evolved in recent years, with higher rates of patency and freedom from TLR. However, the utility of these treatment strategies in terms of reduction of amputations and overall survival remains in question.