Qiao Xuan, Zhang Wen-Jiao, Guo Wen-Fen, Li Yan, Liang Xi-Ying, Wang Zhi-Lu
The First Clinical Medical College of Lanzhou University, Lanzhou, China.
Department of Cardiology, Baiyin Third People's Hospital, Baiyin, China.
Front Cardiovasc Med. 2021 Apr 20;8:598046. doi: 10.3389/fcvm.2021.598046. eCollection 2021.
The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. However, there is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis. PubMed, Embase, the Cochrane library and Web of science databases were systemically searched before March, 2021. Randomized controlled trials and observational studies were included to compare the second-generation drug-eluting stents with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The clinical outcomes were major adverse cardiac events (MACE), target vessel revascularization, myocardial infarction, all-cause death. Fixed effects models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each clinical outcome. Sensitivity analysis was performed to detect potential sources of heterogeneity. Subgroup analyses were used to assess the differential effects. The meta-analysis included eight studies involving 4,583 patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. Pooled analysis showed that the incidence of MACE (OR = 0.68, 95%CI 0.54-0.85, = 0.0008), target vessel revascularization (OR = 0.70, 95%CI 0.54-0.91, = 0.007), and myocardial infarction (OR = 0.58, 95%CI 0.37-0.93, = 0.02) were lower in the second-generation drug-eluting stents compared with the first-generation ones. However, there was not difference in all-cause deaths between two drug-eluting stents (OR = 0.67, 95%CI 0.45-1.01, = 0.05). The second-generation drug-eluting stents are associated with lower MACE, target vessel revascularization, and myocardial infarction compared with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The results of this study can provide a reference for the selection of stents in patients with chronic total occlusion lesion. Further randomized controlled trials are needed to verify that the second-generation drug-eluting stents is superior to the first-generation ones in patients with chronic total occlusion (Registered by PROSPERO, CRD42020158406).
第二代药物洗脱支架已被用于治疗慢性完全闭塞病变。然而，关于在接受经皮冠状动脉介入治疗的慢性完全闭塞病变患者中，第二代药物洗脱支架是否优于第一代药物洗脱支架，临床结局的证据有限。本研究旨在通过荟萃分析比较两代药物洗脱支架在这类患者中的临床结局差异。在2021年3月之前，系统检索了PubMed、Embase、Cochrane图书馆和Web of science数据库。纳入随机对照试验和观察性研究，以比较接受经皮冠状动脉介入治疗的慢性完全闭塞病变患者中第二代药物洗脱支架与第一代药物洗脱支架的情况。临床结局为主要不良心脏事件（MACE）、靶血管血运重建、心肌梗死、全因死亡。采用固定效应模型计算各临床结局的比值比（OR）和95%置信区间（CI）。进行敏感性分析以检测异质性的潜在来源。采用亚组分析评估差异效应。该荟萃分析纳入了8项研究，涉及4583例接受经皮冠状动脉介入治疗的慢性完全闭塞病变患者。汇总分析显示，与第一代药物洗脱支架相比，第二代药物洗脱支架的MACE发生率（OR = 0.68，95%CI 0.54 - 0.85，P = 0.0008）、靶血管血运重建发生率（OR = 0.70，95%CI 0.54 - 0.91，P = 0.007）和心肌梗死发生率（OR = 0.58，95%CI 0.37 - 0.93，P = 0.02）较低。然而，两种药物洗脱支架在全因死亡方面没有差异（OR = 0.67，95%CI 0.45 - 1.01，P = 0.05）。在接受经皮冠状动脉介入治疗的慢性完全闭塞病变患者中，与第一代药物洗脱支架相比，第二代药物洗脱支架与较低的MACE、靶血管血运重建和心肌梗死相关。本研究结果可为慢性完全闭塞病变患者支架的选择提供参考。需要进一步的随机对照试验来验证在慢性完全闭塞患者中第二代药物洗脱支架优于第一代药物洗脱支架（由PROSPERO注册，CRD42020158406）。
