药物涂层球囊治疗冠状动脉疾病的疗效：一项贝叶斯网络荟萃分析
Efficacy of Drug-Coated Balloon Approaches for Coronary Artery Diseases: A Bayesian Network Meta-Analysis.
作者信息
Zhong Peng-Yu, Ma Ying, Shang Yao-Sheng, Niu Ying, Bai Nan, Wang Zhi-Lu
机构信息
Department of Cardiology, Nanchong Central Hospital, Nanchong, China.
The First Clinical Medical College of Lanzhou University, Lanzhou, China.
出版信息
Front Cardiovasc Med. 2022 Jun 21;9:899701. doi: 10.3389/fcvm.2022.899701. eCollection 2022.
BACKGROUND AND OBJECTIVE
The coronary lesions are the most common form of coronary artery disease, and stent implantation still is the main therapeutic strategy. This network meta-analysis aims to evaluate the efficacy of drug-coated balloons only (DCB only) and DCB combined with bare-metal stents (DCB+BMS) strategies vs. drug-eluting stents (DES) and BMS approaches in coronary artery lesion.
METHOD
PubMed, EMBASE, and Cochrane Library databases were retrieved to include the relevant randomized controlled trials that compared DCB approaches and stents implantation in patients with coronary artery diseases. The primary outcome was major adverse cardiac events (MACE). The clinical outcomes included target lesion revascularization (TLR), all-cause death, and myocardial infarction. The angiographic outcomes consisted of in-segment late lumen loss (LLL) and binary restenosis. The odds ratio (OR) and 95% confidence intervals (95% CIs) for dichotomous data, and weighted mean differences for continuous data were calculated in the Bayesian network frame.
RESULT
A total of 26 randomized controlled trials and 4,664 patients were included in this study. The DCB-only strategy was comparable with the efficacy of MACE, clinical outcomes, and binary restenosis compared with DES. In addition, this strategy can significantly reduce the in-segment LLL compared with the first-generation (MD -0.29, -0.49 to -0.12) and the second-generation DES (MD -0.15, -0.27 to -0.026). However, subgroup analysis suggested that DCB only was associated with higher in-segment LLL than DES (MD 0.33, 0.14 to 0.51) in patients with acute coronary syndrome. Compared with DES, the DCB+BMS strategy had a similar incidence of myocardial infarction and all-cause death, but a higher incidence of MACE, TLR, and angiographic outcomes. In addition, DCB+BMS was associated with a similar incidence of myocardial infarction and all-cause death than BMS, with a lower incidence of MACE, TLR, and angiographic outcomes.
CONCLUSION
The DCB only is associated with similar efficacy and lower risk of LLL compared with DES. In addition, the DCB+BMS strategy is superior to BMS alone but inferior to DES (PROSPERO, CRD 42021257567).
SYSTEMATIC REVIEW REGISTRATION
背景与目的
冠状动脉病变是冠状动脉疾病最常见的形式，支架植入仍是主要的治疗策略。这项网状荟萃分析旨在评估单纯药物涂层球囊（仅DCB）以及药物涂层球囊联合裸金属支架（DCB+BMS）策略与药物洗脱支架（DES）和裸金属支架（BMS）方法在冠状动脉病变中的疗效。
方法
检索PubMed、EMBASE和Cochrane图书馆数据库，纳入比较DCB方法与冠状动脉疾病患者支架植入的相关随机对照试验。主要结局是主要不良心脏事件（MACE）。临床结局包括靶病变血运重建（TLR）、全因死亡和心肌梗死。血管造影结局包括节段内晚期管腔丢失（LLL）和二元再狭窄。在贝叶斯网络框架中计算二分数据的比值比（OR）和95%置信区间（95%CI）以及连续数据的加权平均差。
结果
本研究共纳入26项随机对照试验和4664例患者。与DES相比，仅DCB策略在MACE疗效、临床结局和二元再狭窄方面相当。此外，与第一代DES（MD -0.29，-0.49至-0.12）和第二代DES（MD -0.15，-0.27至-0.026）相比，该策略可显著降低节段内LLL。然而，亚组分析表明，在急性冠状动脉综合征患者中，仅DCB的节段内LLL高于DES（MD 0.33，0.14至0.51）。与DES相比，DCB+BMS策略的心肌梗死和全因死亡发生率相似，但MACE、TLR和血管造影结局的发生率较高。此外，DCB+BMS与BMS的心肌梗死和全因死亡发生率相似，MACE、TLR和血管造影结局的发生率较低。
结论
与DES相比，仅DCB的疗效相似且LLL风险较低。此外，DCB+BMS策略优于单独使用BMS，但劣于DES（国际前瞻性系统评价注册库，CRD 42021257567）。
系统评价注册
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