经皮冠状动脉介入治疗后伴或不伴糖尿病的患者药物洗脱支架的早期和晚期支架血栓形成：系统评价和荟萃分析。

Early and Late Stent Thrombosis in Patients with Versus Without Diabetes Mellitus Following Percutaneous Coronary Intervention with Drug-Eluting Stents: A Systematic Review and Meta-Analysis.

机构信息

Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China.

出版信息

Am J Cardiovasc Drugs. 2018 Dec;18(6):483-492. doi: 10.1007/s40256-018-0295-y.

DOI:10.1007/s40256-018-0295-y

PMID:30132141

Abstract

BACKGROUND

Nowadays, drug-eluting stents (DES) are most commonly used compared with bare metal stents (BMS) since the former are associated with significantly lower rates of revascularization following percutaneous coronary intervention (PCI). However, unpredictable in-stent thrombosis is a major concern with DES, especially in patients with diabetes mellitus.

OBJECTIVE

In this analysis, we aimed to systematically compare early and late stent thrombosis in patients with versus without diabetes mellitus following PCI with DES.

METHODS

Studies were included if they were randomized controlled trials or observational studies comparing patients with diabetes mellitus versus those without it following PCI with DES and they reported acute and sub-acute/early and late stent thrombosis among their clinical outcomes. Early stent thrombosis was defined as stent thrombosis that occurred before 30 days and late stent thrombosis was defined as stent thrombosis that occurred after 30 days following PCI. The statistical analysis was carried out by the new version of the RevMan software (version 5.3), and odds ratios (ORs) and 95% confidence intervals (CIs) were considered as the statistical parameters.

RESULTS

A total number of 18,910 patients were included in this analysis comparing early and late stent thrombosis in patients with diabetes mellitus (5123 patients) and in patients without diabetes mellitus (13,787 patients). Both groups of patients had similar rates of early stent thrombosis, with an OR of 1.30 (95% CI 0.89-1.91; P = 0.18, I = 9%) (4962 patients with diabetes mellitus were compared with 13,392 patients without diabetes mellitus). However, late stent thrombosis was significantly higher in patients with diabetes mellitus, with an OR of 1.95 (95% CI 1.35- 2.81; P = 0.0004, I = 0%) (5113 patients with diabetes mellitus and 13,775 patients without diabetes mellitus were compared).

CONCLUSIONS

Both patients with and without diabetes mellitus had a similar rate of early stent thrombosis following PCI with DES. However, diabetes mellitus was associated with a significantly higher rate of late stent thrombosis.

摘要

背景

与裸金属支架（BMS）相比，药物洗脱支架（DES）目前应用更为广泛，因为前者经皮冠状动脉介入治疗（PCI）后的血运重建率明显较低。然而，DES 存在不可预测的支架内血栓形成，这是一个主要问题，尤其是在糖尿病患者中。

目的

在这项分析中，我们旨在系统比较经 DES PCI 后合并与不合并糖尿病患者的早期和晚期支架血栓形成。

方法

如果研究为比较经 DES PCI 后合并与不合并糖尿病患者的随机对照试验或观察性研究，且报告了其临床结局中的急性和亚急性/早期和晚期支架血栓形成，则纳入本研究。早期支架血栓形成定义为 PCI 后 30 天内发生的支架血栓形成，晚期支架血栓形成定义为 PCI 后 30 天发生的支架血栓形成。统计分析由新版本的 RevMan 软件（版本 5.3）进行，采用比值比（OR）和 95%置信区间（CI）作为统计参数。

结果

本分析共纳入 18910 例患者，比较了合并糖尿病（5123 例）和不合并糖尿病（13787 例）患者的早期和晚期支架血栓形成。两组患者的早期支架血栓形成发生率相似，OR 为 1.30（95%CI 0.89-1.91；P=0.18，I=9%）（4962 例合并糖尿病患者与 13392 例不合并糖尿病患者比较）。然而，合并糖尿病患者的晚期支架血栓形成发生率显著较高，OR 为 1.95（95%CI 1.35-2.81；P=0.0004，I=0%）（5113 例合并糖尿病患者与 13775 例不合并糖尿病患者比较）。