Wang Jiarong, Chen Xiyang, Zhao Jichun, Zhang Wayne W
Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA.
Ann Vasc Surg. 2022 Sep;85:1-8.e5. doi: 10.1016/j.avsg.2022.04.039. Epub 2022 May 11.
Recent evidence raised the concern that paclitaxel-containing therapy was associated with an increased risk of mortality in patients with peripheral artery diseases (PADs). However, it is unclear whether drug-eluting stent (DES) versus drug-coated balloon (DCB) have a different effect on mortality of PAD patients. Our study aimed to systematically review current literature comparing clinical outcomes of patients treated with DES versus DCB for PAD.
MEDLINE and Embase were searched for eligible studies from January 2000 to December 31, 2020. Randomized controlled trials (RCTs) or cohort studies that reported outcomes of DES versus DCB were included in our study. The primary outcome was 12-month all-cause mortality. A random-effect model was used to pool the odds ratios (ORs) and related 95% confidence intervals (CIs).
Our review included 7 studies, involving 2 RCTs and 5 cohort studies. A total of 4,237 patients with DES and 9,234 patients with DCB were analyzed. All included cohort studies were of high quality with Newcastle-Ottawa scores from 7 to 8. No significant difference in 12-month all-cause mortality was found between DES and DCB without significant heterogeneity (OR 1.02, 95% CI 0.91-1.14, I = 0%). As for primary patency, no significant difference between treatments was observed (OR 1.27, 95% CI 0.75-2.15, I = 55%). Similar results were observed for freedom from target lesion revascularization (OR 0.94, 95% CI 0.64-1.40, I = 0%).
This systematic review and meta-analysis suggest that no significant difference in 12-month all-cause mortality was found between DES and DCB. Primary patency and freedom from target lesion revascularization of lower extremity PAD were also comparable between the 2 groups.
最近有证据引发了人们对含紫杉醇治疗与外周动脉疾病（PAD）患者死亡风险增加相关的担忧。然而，药物洗脱支架（DES）与药物涂层球囊（DCB）对PAD患者死亡率的影响是否不同尚不清楚。我们的研究旨在系统回顾比较DES与DCB治疗PAD患者临床结局的当前文献。
检索MEDLINE和Embase数据库，查找2000年1月1日至2020年12月31日期间的合格研究。纳入我们研究的是报告DES与DCB结局的随机对照试验（RCT）或队列研究。主要结局是12个月全因死亡率。采用随机效应模型汇总比值比（OR）和相关的95%置信区间（CI）。
我们的综述纳入了7项研究，包括2项RCT和5项队列研究。共分析了4237例接受DES治疗的患者和9234例接受DCB治疗的患者。所有纳入的队列研究质量都很高，纽卡斯尔-渥太华评分在7至8分之间。DES与DCB之间在12个月全因死亡率方面未发现显著差异，且无显著异质性（OR 1.02，95%CI 0.91-1.14，I² = 0%）。至于主要通畅率，治疗组之间未观察到显著差异（OR 1.27，95%CI 0.75-2.15，I² = 55%）。在免于靶病变血运重建方面也观察到类似结果（OR 0.94，95%CI 0.64-1.40，I² = 0%）。
这项系统综述和荟萃分析表明，DES与DCB在12个月全因死亡率方面未发现显著差异。两组下肢PAD的主要通畅率和免于靶病变血运重建情况也相当。
