用于经皮治疗慢性完全性冠状动脉闭塞的生物可吸收血管支架：一项荟萃分析。
Bioresorbable vascular scaffolds for percutaneous treatment of chronic total coronary occlusions: a meta-analysis.
作者信息
Polimeni Alberto, Anadol Remzi, Münzel Thomas, Geyer Martin, De Rosa Salvatore, Indolfi Ciro, Gori Tommaso
机构信息
Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany.
Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, 88100, Catanzaro, Italy.
出版信息
BMC Cardiovasc Disord. 2019 Mar 15;19(1):59. doi: 10.1186/s12872-019-1042-2.
BACKGROUND
BRS represent a new approach to treating coronary artery disease. Beneficial properties of BRS regarding the restoration of vasomotility after resorption make them attractive devices in CTO revascularization. However, experience in this setting is limited.
METHODS
We systematically searched Medline, Scholar, and Scopus for reports of at least 9 patients with CTO undergoing BRS implantation. Patients' and procedural characteristics were summarized. The primary outcome of interest was target lesion revascularization (TLR). Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42017069322).
RESULTS
Thirteen reports for a total of 843 lesions with a median follow-up of 12 months (IQR 6-12) were included in the analysis. At short-term, the summary estimate rate of TLR was 2.6% (95% CI: 1 to 4%, I = 0%, P = 0.887) while at mid to long-term it was 3.8% (95% CI: 2 to 6%, I = 0%, P = 0.803). At long-term follow-up (≥12 months), the summary estimate rate of cardiac death was 1.1% (95% CI: 0 to 2%, I = 0%, P = 0.887). The summary estimate rates of scaffold thrombosis and clinical restenosis were respectively 0.9% (95% CI: 0 to 2%, I = 0%, P = 0.919) and 1.8% (95% CI: 0 to 4%, I = 0%, P = 0.448). Finally, the summary estimate rate of target vessel revascularization was 6.6% (95% CI: 0 to 11%, I = 0%, P = 0.04).
CONCLUSIONS
Implantation of BRS in a population with CTO is feasible, although further longer-term outcome studies are necessary.
背景
生物可吸收支架（BRS）代表了一种治疗冠状动脉疾病的新方法。BRS在吸收后恢复血管舒缩功能方面的有益特性使其成为慢性完全闭塞病变（CTO）血运重建中有吸引力的器械。然而，在这种情况下的经验有限。
方法
我们系统检索了Medline、Scholar和Scopus数据库，以获取至少9例接受BRS植入的CTO患者的报告。总结了患者和手术特征。感兴趣的主要结局是靶病变血运重建（TLR）。使用随机效应荟萃分析计算合并估计值。该研究方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42017069322）中注册。
结果
分析纳入了13篇报告，共843个病变，中位随访时间为12个月（四分位间距6 - 12个月）。短期时，TLR的汇总估计率为2.6%（95%置信区间：1%至4%，I² = 0%，P = 0.887），而中长期时为3.8%（95%置信区间：2%至6%，I² = 0%，P = 0.803）。长期随访（≥12个月）时，心源性死亡的汇总估计率为1.1%（95%置信区间：0%至2%，I² = 0%，P = 0.887）。支架内血栓形成和临床再狭窄的汇总估计率分别为0.9%（95%置信区间：0%至2%，I² = 0%，P = 0.919）和1.8%（95%置信区间：0%至4%，I² = 0%，P = 0.448）。最后，靶血管血运重建的汇总估计率为6.6%（95%置信区间：0%至11%，I² = 0%，P = 0.04）。
结论
在CTO人群中植入BRS是可行的，尽管有必要进行进一步的长期结局研究。
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