Jaff Michael R, Nelson Teresa, Ferko Nicole, Martinson Melissa, Anderson Louise H, Hollmann Sarah
Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462.
Technomics Research, LLC, Minneapolis, Minnesota.
J Vasc Interv Radiol. 2017 Dec;28(12):1617-1627.e1. doi: 10.1016/j.jvir.2017.08.003. Epub 2017 Oct 12.
To use network meta-analysis (NMA) to determine the optimal endovascular strategy for management of femoropopliteal peripheral artery disease (PAD) given the lack of multiple prospective randomized trials to guide treatment decisions.
NMA is a new meta-analytic method that permits comparisons among any 2 therapies by combining results of a collection of clinical trials conducted in the same or similar patient population. NMA was used to analyze data from 15 randomized controlled trials (RCTs) and 10 prospective, multicenter, single-arm trials (combined evidence [CE] NMA) that evaluated target lesion revascularization (TLR) for 5 endovascular strategies: bare metal stent (BMS), polymer-covered metal stent (CMS), drug-eluting stent (DES), drug-coated balloon (DCB) and percutaneous transluminal angioplasty (PTA).
The RCT and CE NMAs included 2,912 (6,091) patients with 3,151 (6,786) person-years of follow-up. In the CE NMA, DCB provided a statistically significant 68% reduction in TLR compared with PTA and a statistically significant 53% reduction in TLR compared with BMS. BMS, CMS, and DES provided reductions in TLR of 33%, 48%, and 58% compared with PTA, with statistical significance achieved for CMS and DES. The significant reductions in TLR for DCB compared with PTA and BMS were replicated in the RCT NMA.
This NMA demonstrated that DCB provided better reduction in TLR rates compared with PTA and BMS.
鉴于缺乏多项前瞻性随机试验来指导治疗决策，采用网络荟萃分析（NMA）确定股腘动脉外周动脉疾病（PAD）管理的最佳血管内治疗策略。
NMA是一种新的荟萃分析方法，通过合并在相同或相似患者群体中进行的一系列临床试验结果，允许对任意两种治疗方法进行比较。NMA用于分析来自15项随机对照试验（RCT）和10项前瞻性、多中心、单臂试验（联合证据[CE]NMA）的数据，这些试验评估了5种血管内治疗策略的靶病变血运重建（TLR）：裸金属支架（BMS）、聚合物涂层金属支架（CMS）、药物洗脱支架（DES）、药物涂层球囊（DCB）和经皮腔内血管成形术（PTA）。
RCT和CE NMA纳入了2912例（6091例）患者，随访3151人年（6786人年）。在CE NMA中，与PTA相比，DCB使TLR显著降低68%，与BMS相比，TLR显著降低53%。与PTA相比，BMS、CMS和DES使TLR分别降低33%、48%和58%，CMS和DES达到统计学显著性。与PTA和BMS相比，DCB的TLR显著降低在RCT NMA中得到了重复。
该NMA表明，与PTA和BMS相比，DCB能更好地降低TLR率。
