李琴.直接支架术与预扩张支架术治疗急性冠脉综合征疗效与安全性的Meta分析[J].内科急危重症杂志,2017,23(4):
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| 中文关键词: 直接支架术 预扩张支架术 急性冠脉综合征 经皮冠状动脉介入治疗 Meta分析 |
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| 中文摘要: |
| 目的 评价急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)时直接支架术(DS)和球囊预扩张后支架术(CS)两种介入方法的有效性及安全性。方法 计算机检索 PubMed、EMBASE、Cochrane图书馆、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)和中国科技期刊数据库(VIP),检索时间从建库截至2016年4月,纳入中英文关于冠脉内直接支架术和预扩张支架术的临床研究。由两位研究者按照纳入与排除标准独立进行文献筛选、资料提取并评价纳入研究的方法学质量后,采用Cochrane协作网提供的RevMan5.3统计软件进行Meta分析。结果 经筛选后共纳入文献13篇,其中4项为随机对照试验,8项研究进行了临床随访,包括9090例患者,其中DS组2765 (30.4%)例,CS组6325 (69.6%)例。Meta分析结果显示：与行DS组患者比,CS组患者增加了患者介入治疗院内和术后30天主要不良心血管事件(MACE)的发生率(OR=1.65, 95%CI:1.25-2.18, P=0.0004)；CS组患者PCI术中无复流的发生率较DS组更高(OR=1.96,95%CI:1.29-2.97, P=0.002)；在长期生存率方法,CS组患者PCI术后1年死亡率明显高于DS组(5.86% vs. 2.51%, OR=2.47,95%CI:1.76-3.48, P<0.00001)。结论 在ACS患者行PCI术中,DS较CS治疗成功率更高,并发症更低,具有较好的近期临床疗效。然而,该结论还需大量良好设计的随机对照研究予以证实。 |
| 英文摘要: |
| Objective To evaluate the efficacy and safety of direct stenting (DS) versus conventional stenting (CS) for patients with acute coronary syndrome (ACS). Methods A search was retrieved from Pubmed, EMbase, Cochrane Library, Chinese Journal Full-text Database (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP) to systematically collect the randomized controlled trials of DS vs. CS for the patients with ACS undergoing PCI from inception to April 2016. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was performed using RevMan 5.3 software. Results Thirteen studies involving 9090 patients met the inclusion criteria. Of these, 4 were RCT study, 8 have the follow-up results. The results of meta-analysis showed that the incidence of MACE within 30 days (OR=1.65, 95%CI:1.25-2.18, P=0.0004) were significantly higher in the patients by CS strategy than those by DS strategy. The no-reflow phenomenon in PCI procedure was significantly higher in the CS group compared with the DS group(OR=1.96,95%CI:1.29-2.97, P=0.002). Also, the 1 year mortality was significantly increased in CS group compared with DS group. |
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