中国循证医学杂志

中国循证医学杂志

单支架与双支架治疗策略对冠状动脉分叉病变预后影响的系统评价

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目的系统评价单支架与双支架治疗策略对冠状动脉分叉病变预后的影响。方法计算机检索 PubMed、The Cochrane Library、EMbase、Web of Science、CBM、WanFang Data、VIP 和 CNKI 数据库,搜集有关单支架与双支架治疗策略对冠状动脉分叉病变预后影响的随机对照试验(RCT),检索时限均从建库至 2017 年 3 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 Stata 12.0 软件进行 Meta 分析。结果共纳入 23 个 RCT,包括 7 391 例患者。Meta 分析结果显示:与双支架治疗策略相比,单支架治疗策略可显著降低冠状动脉分叉病变患者心肌梗死发生率[RR=0.61,95%CI(0.50,0.73),P<0.001]。但两种治疗策略的全因死亡率、心源性死亡率、主要不良心血管事件(MACE)发生率、靶病变血运重建(TLR)发生率及支架内血栓形成发生率差异均无统计学意义。亚组分析结果显示:与双支架治疗策略相比,单支架治疗策略 5 年全因死亡率明显降低[RR=0.59,95%CI(0.40,0.88),P=0.01]。结论与双支架治疗策略相比,单支架治疗策略可显著降低冠状动脉分叉病变患者术后心肌梗死发生率和 5 年全因死亡率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

ObjectivesTo systematically review the influence of single-stent versus double-stent strategy for coronary bifurcation lesions prognosis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, WanFang Data, VIP and CNKI databases were searched online to collect randomized controlled trials (RCTs) of single-stent versus double-stent strategy for coronary bifurcation lesions from inception to March, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 23 RCTs involving 7 391 patients were included. The results of meta-analysis showed that: compared to the double-stent strategy, the single-stent strategy significantly reduced the myocardial infarction rate (RR=0.61, 95%CI 0.50 to 0.73, P<0.001). There were no significant differences between two groups in all cause mortality, cardiac mortality, main adverse coronary event (MACE), target lesion revascularization (TLR) and stent thrombosis. The results of subgroup analysis showed that: single-stent strategy for coronary bifurcation lesions was associated with lower all-cause mortality at five-years follow-up (RR=0.59, 95%CI 0.40 to 0.88,P=0.01).ConclusionsCurrent evidence shows that single-stent strategy for coronary bifurcation lesions could reduce the myocardial infarction rate and five-year mortality compared to double-stent strategy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关键词: 冠状动脉分叉病变; 单支架治疗策略; 双支架治疗策略; 系统评价; Meta 分析; 随机对照试验

Key words: Coronary bifurcation lesions; Single-stent strategy; Double-stent strategy; Systematic review; Meta-analysis; Randomized controlled trial

引用本文: 朱玉菡, 沈晓旭, 韩晴晴, 赵静, 石晓璐, 陈慧洋, 白云浩. 单支架与双支架治疗策略对冠状动脉分叉病变预后影响的系统评价. 中国循证医学杂志, 2018, 18(2): 192-200. doi: 10.7507/1672-2531.201708079 复制

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