Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis.
Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis.
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DOI：
10.1186/s12947-017-0102-y
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发表时间：
2017-04-12
影响因子：
1.9
通讯作者：
Lerman A
中科院分区：
文献类型：
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作者：
Burneikaitė G;Shkolnik E;Čelutkienė J;Zuozienė G;Butkuvienė I;Petrauskienė B;Šerpytis P;Laucevičius A;Lerman A
系统回顾目前可用的人类心脏冲击波疗法 (CSWT) 研究，并对 CSWT 的抗心绞痛功效进行荟萃分析。对 Cochrane 对照试验注册库、Medline、Medscape、Research Gate、Science Direct 和 Web of Science 数据库进行了探索。共有 39 项研究评估了 CSWT 对稳定型心绞痛患者的疗效，包括单臂试验、非随机试验和随机试验。获得了有关研究设计、受试者特征、临床数据和终点的信息。对发表偏倚风险进行评估，并使用随机效应模型计算研究之间的异质性。 39 项审查研究总共纳入了 1189 名患者，其中 1006 名患者接受了 CSWT 治疗。单臂研究的最大患者样本包括 111 名患者。所有选定的研究都表明心绞痛症状和/或生活质量的主观测量有显着改善，在大多数研究中左心室功能和心肌灌注得到改善。在 12 项对照研究中，涉及 483 名患者（183 名对照者）心绞痛等级、西雅图心绞痛问卷 (SAQ) 评分，治疗后硝酸盐消耗量显着改善。 22 项研究的 593 名参与者中，与基线值相比，CSWT 后运动能力显着提高（荟萃分析标准化平均差 SMD = −0.74；95% CI，-0.97 至 -0.5；p < 0.001）。对稳定型冠状动脉疾病 (CAD) 的 CSWT 研究的系统回顾表明，临床变量得到了持续改善。荟萃分析显示运动能力有所改善。总体而言，CSWT 对于终末期 CAD 患者来说是一种有前途的非侵入性选择，但证据仅限于小样本单中心研究。需要进行多中心、充分的随机双盲研究。
To systematically review currently available cardiac shock-wave therapy (CSWT) studies in humans and perform meta-analysis regarding anti-anginal efficacy of CSWT. The Cochrane Controlled Trials Register, Medline, Medscape, Research Gate, Science Direct, and Web of Science databases were explored. In total 39 studies evaluating the efficacy of CSWT in patients with stable angina were identified including single arm, non- and randomized trials. Information on study design, subject’s characteristics, clinical data and endpoints were obtained. Assessment of publication risk of bias was performed and heterogeneity across the studies was calculated by using random effects model. Totally, 1189 patients were included in 39 reviewed studies, with 1006 patients treated with CSWT. The largest patient sample of single arm study consisted of 111 patients. All selected studies demonstrated significant improvement in subjective measures of angina symptoms and/or quality of life, in the majority of studies left ventricular function and myocardial perfusion improved. In 12 controlled studies with 483 patients included (183 controls) angina class, Seattle Angina Questionnaire (SAQ) score, nitrates consumption were significantly improved after the treatment. In 593 participants across 22 studies the exercise capacity was significantly improved after CSWT, as compared with the baseline values (in meta-analysis standardized mean difference SMD = −0.74; 95% CI, −0.97 to −0.5; p < 0.001). Systematic review of CSWT studies in stable coronary artery disease (CAD) demonstrated consistent improvement of clinical variables. Meta-analysis showed a moderate improvement of exercise capacity. Overall, CSWT is a promising non-invasive option for patients with end-stage CAD, but evidence is limited to small sample single-center studies. Multi-center adequately powered randomised double blind studies are warranted.