Yang Xiuhui, Liu Qingquan, Yuan Lijun, Wang Haoran, Xie Qiaotao
Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College.
Int Heart J. 2018 Nov 28;59(6):1202-1210. doi: 10.1536/ihj.17-583. Epub 2018 Oct 25.
Chronic kidney disease (CKD) patients have worse adverse cardiovascular outcomes after percutaneous coronary intervention (PCI). Clinical outcomes comparing a limus-eluting stent (LES) to a paclitaxel-eluting stent (PES) in patients with CKD remain controversial.A systematic search was conducted using PubMed, EMBASE, and Cochrane Library. A pooled odds ratio (OR) and 95% confidence interval (CI) were used to calculate original data. We conducted heterogeneity, quality assessment, and publication bias analyses.A total of 17 trials involving 10,724 patients were included. No significant differences were found regarding target vessel revascularization, target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality, and major adverse cardiac events (MACE) between first-generation LES implantation and PES implantation. Second-generation LES implantation was associated with lower rates of all-cause mortality (OR, 0.56; 95% CI, 0.39-0.82; P = 0.003), MACE (OR, 0.61; 95% CI, 0.38-0.97; P = 0.04), and ST (OR, 0.45; 95% CI, 0.26-0.77; P = 0.004) compared with PES implantation. In all, the long-term all-cause mortality rate was significantly lower after LES implantation than after PES implantation in patients with CKD (OR, 0.78; 95% CI, 0.66-0.93; P = 0.004). However, second-generation LES implantation resulted in a higher rate of TLR (OR, 2.23; 95% CI, 1.53-3.25; P < 0.001) than PES implantation in dialysis patients.In patients with CKD, first-generation LES and PES implantation had comparable mortality and morbidity. Second-generation LES implantation was superior to PES in reducing long-term mortality, MACE, and ST. However, PES may be more effective than LES in dialysis patients.
慢性肾脏病（CKD）患者经皮冠状动脉介入治疗（PCI）后不良心血管结局更差。比较CKD患者中雷帕霉素洗脱支架（LES）与紫杉醇洗脱支架（PES）的临床结局仍存在争议。使用PubMed、EMBASE和Cochrane图书馆进行了系统检索。采用合并比值比（OR）和95%置信区间（CI）来计算原始数据。我们进行了异质性、质量评估和发表偏倚分析。
共纳入17项试验，涉及10724例患者。第一代LES植入与PES植入在靶血管血运重建、靶病变血运重建（TLR）、支架血栓形成（ST）、心肌梗死（MI）、全因死亡率和主要不良心脏事件（MACE）方面未发现显著差异。与PES植入相比，第二代LES植入与较低的全因死亡率（OR，0.56；95%CI，0.39 - 0.82；P = 0.003）、MACE（OR，0.61；95%CI，0.38 - 0.97；P = 0.04）和ST（OR，0.45；95%CI，0.26 - 0.77；P = 0.004）相关。总体而言，CKD患者中LES植入后的长期全因死亡率显著低于PES植入后（OR，0.78；95%CI，0.66 - 0.93；P = 0.004）。然而，在透析患者中，第二代LES植入导致的TLR发生率高于PES植入（OR，2.23；95%CI，1.53 - 3.25；P < 0.001）。
在CKD患者中，第一代LES和PES植入的死亡率和发病率相当。第二代LES植入在降低长期死亡率、MACE和ST方面优于PES。然而，在透析患者中，PES可能比LES更有效。
