Bittl John A, Chew Derek P, Topol Eric J, Kong David F, Califf Robert M
Ocala Heart Institute, Munroe Regional Medical Center, 1511 SW 1st Avenue, Ocala, Florida 34474, USA.
J Am Coll Cardiol. 2004 Mar 17;43(6):936-42. doi: 10.1016/j.jacc.2003.10.039.
We conducted a systematic overview (meta-analysis) of randomized trials of balloon angioplasty versus coronary atherectomy, laser angioplasty, or cutting balloon atherotomy to evaluate the effects of plaque modification during percutaneous coronary intervention.
Several mechanical approaches have been developed that ablate or section atheromatous plaque during percutaneous coronary interventions to optimize acute results, minimize intimal injury, and reduce complications and restenosis.
Sixteen trials (9,222 patients) constitute the randomized controlled experience with atherectomy, laser, or atherotomy versus balloon angioplasty with or without coronary stenting. Each trial tested the hypothesis that ablative therapy would result in better clinical or angiographic results than balloon dilation alone.
Short-term death rates (<31 days) were not improved by the use of ablative procedures (0.3% vs. 0.4%, odds ratio [OR] 0.94 [95% confidence interval 0.46 to 1.92]), but periprocedural myocardial infarctions (4.4% vs. 2.5%, OR 1.83 [95% CI 1.43 to 2.34]) and major adverse cardiac events (5.1% vs. 3.3%, OR 1.54 [95% CI 1.25 to 1.89]) were increased. Angiographic restenosis rates (6,958 patients) were not improved with the ablative devices (38.9% vs. 37.4%, OR 1.06 [95% CI 0.97 to 1.17]). No reduction in revascularization rates (25.2% vs. 24.5%, OR 1.04 [95% CI 0.94 to 1.14]) or cumulative adverse cardiac events rates up to one year after treatment were seen with ablative devices (27.8% vs. 26.1%, OR 1.09 [95% CI 0.99 to 1.20]).
The combined experience from randomized trials suggests that ablative devices failed to achieve predefined clinical and angiographic outcomes. This meta-analysis does not support the hypothesis that routine ablation or sectioning of atheromatous tissue is beneficial during percutaneous coronary interventions.
我们对球囊血管成形术与冠状动脉斑块旋切术、激光血管成形术或切割球囊血管切开术的随机试验进行了系统综述（荟萃分析），以评估经皮冠状动脉介入治疗期间斑块修饰的效果。
已开发出几种机械方法，在经皮冠状动脉介入治疗期间消融或切除动脉粥样硬化斑块，以优化急性治疗效果、最小化内膜损伤并减少并发症和再狭窄。
16项试验（9222例患者）构成了斑块旋切术、激光治疗或血管切开术与球囊血管成形术（伴或不伴冠状动脉支架置入）的随机对照经验。每项试验都检验了以下假设：消融治疗比单纯球囊扩张能产生更好的临床或血管造影结果。
使用消融手术并未改善短期死亡率（<31天）（0.3%对0.4%，优势比[OR]0.94[95%置信区间0.46至
