比较 80 岁以上老年人使用冠状动脉 DES 和 BMS 的效果：一项系统评价和荟萃分析。
Comparison of coronary DES and BMS in octogenarians: A systematic review and meta-analysis.
机构信息
Institute of Geriatric Cardiology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
出版信息
J Geriatr Cardiol. 2013 Dec;10(4):336-43. doi: 10.3969/j.issn.1671-5411.2013.04.004.
OBJECTIVE
Uncertainty exists regarding the relative performance of drug-eluting stents (DES) versus bare-metal stents (BMS) in octogenarians undergoing percutaneous coronary intervention (PCI). We undertook a meta-analysis to assess outcomes for DES and BMS in octogenarians undergoing PCI.
METHODS
Electronic data bases of PubMed, Cochrane, and EMBASE were searched. We included randomized, controlled clinical trials (RCT) and observational studies comparing DES and BMS in octogenarians receiving PCI. The methodological qualities of eligible trials were assessed using a "risk of bias" tool. The endpoints included all-cause death, major adverse cardiac events (MACE), myocardial infarction (MI), target vessel revascularization (TVR), major bleeding, and stent thrombosis (ST). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for each endpoint.
RESULTS
A total of one RCT and six observational studies were included and analyzed in this meta-analysis. All trials were of acceptable quality. At 30 days, compared with DES-treated patients, BMS-treated patients had a higher incidence of mortality (OR: 3.91, 95% CI: 1.10-13.91; P = 0.03). The OR for MACE (1.52, 95% CI: 0.56-4.17; P = 0.13), MI (0.81, 95% CI: 0.37-2.17; P = 0.23), TVR (0.75, 95% CI: 0.17-3.41; P = 0.41), major bleeding (0.77, 95% CI: 0.35-1.68; P = 0.43), and ST (1.44, 95% CI: 0.32-6.45; P = 0.33) did not reach statistical significance. At one year follow-up, the OR did not favor BMS over MACE (MACE, defined as the composite of death, myocardial infarction, and TVR) (1.87; 95% CI: 1.22-2.87; P < 0.01), MI (1.91, 95% CI: 1.22-2.99; P < 0.01), TVR (3.08, 95% CI: 1.80-5.26; P < 0.01) and ST (3.37, 95% CI: 1.12-10.13; P < 0.01). The OR for mortality (1.51; 95% CI: 0.92-2.47; P = 0.10) and major bleeding (0.85, 95% CI: 0.47-1.55; P = 0.60) did not reach statistical significance. At > 1 year follow-up, the OR for all endpoints, including mortality, MACE, MI, TVR, major bleeding, and ST, did not reach statistical significance.
CONCLUSIONS
Our meta-analysis suggests that DES is associated with favorable outcomes as compared with BMS in octogenarians receiving PCI.
目的
在接受经皮冠状动脉介入治疗（PCI）的 80 岁以上患者中，药物洗脱支架（DES）与金属裸支架（BMS）的相对疗效尚不确定。我们进行了一项荟萃分析，以评估 80 岁以上接受 PCI 的患者中使用 DES 和 BMS 的结果。
方法
检索 PubMed、Cochrane 和 EMBASE 的电子数据库。我们纳入了比较接受 PCI 的 80 岁以上患者使用 DES 和 BMS 的随机对照临床试验（RCT）和观察性研究。使用“偏倚风险”工具评估合格试验的方法学质量。终点包括全因死亡、主要不良心脏事件（MACE）、心肌梗死（MI）、靶血管血运重建（TVR）、大出血和支架血栓形成（ST）。计算每个终点的比值比（OR）和 95%置信区间（95%CI）。
结果
共纳入一项 RCT 和六项观察性研究进行荟萃分析。所有试验的质量均为可接受水平。在 30 天内，与 DES 治疗的患者相比，BMS 治疗的患者死亡率更高（OR：3.91，95%CI：1.10-13.91；P = 0.03）。MACE（OR：1.52，95%CI：0.56-4.17；P = 0.13）、MI（OR：0.81，95%CI：0.37-2.17；P = 0.23）、TVR（OR：0.75，95%CI：0.17-3.41；P = 0.41）、大出血（OR：0.77，95%CI：0.35-1.68；P = 0.43）和 ST（OR：1.44，95%CI：0.32-6.45；P = 0.33）的 OR 均无统计学意义。在一年随访时，BMS 并不优于 MACE（定义为死亡、心肌梗死和 TVR 的复合终点）（OR：1.87；95%CI：1.22-2.87；P < 0.01）、MI（OR：1.91，95%CI：1.22-2.99；P < 0.01）、TVR（OR：3.08，95%CI：1.80-5.26；P < 0.01）和 ST（OR：3.37，95%CI：1.12-10.13；P < 0.01）。死亡率（OR：1.51；95%CI：0.92-2.47；P = 0.10）和大出血（OR：0.85，95%CI：0.47-1.55；P = 0.60）的 OR 无统计学意义。在> 1 年随访时，所有终点的 OR，包括死亡率、MACE、MI、TVR、大出血和 ST，均无统计学意义。
结论
我们的荟萃分析表明，与 BMS 相比，DES 在接受 PCI 的 80 岁以上患者中与更好的结果相关。
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