冠状静脉窦减压器对难治性心绞痛患者的疗效：一项系统评价与荟萃分析
The Efficacy of Coronary Sinus Reducer in Patients with Refractory Angina: A Systematic Review and Meta-Analysis.
作者信息
Theofilis Panagiotis, Vlachakis Panayotis K, Sagris Marios, Mantzouranis Emmanouil, Sakalidis Athanasios, Soulaidopoulos Stergios, Chasikidis Christos, Oikonomou Evangelos, Tsioufis Konstantinos, Tousoulis Dimitris
机构信息
1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, 11527 Athens, Greece.
3rd Cardiology Department, "Sotiria" Regional Hospital for Chest Diseases, University of Athens Medical School, 11527 Athens, Greece.
出版信息
Rev Cardiovasc Med. 2024 Mar 4;25(3):82. doi: 10.31083/j.rcm2503082. eCollection 2024 Mar.
BACKGROUND
Refractory angina is a frequently encountered phenomenon in patients with coronary artery disease, often presenting therapeutic challenges to the clinical cardiologist. Novel treatment methods have been explored in this direction, with the coronary sinus reducer (CSR) being among the most extensively-investigated.
METHODS
We conducted a systematic review of the literature for studies assessing the efficacy of CSR in patients with refractory angina. The primary endpoints of interest were procedural success and the improvement in angina according to the Canadian Cardiovascular Society (CCS) by at least one class. Secondary endpoints were the rate of periprocedural adverse events, the improvement by at least 2 CCS classes, and the mean change in CCS class. A random-effects meta-analysis of proportions (procedural success, improvement by 1 or 2 classes, periprocedural adverse events) or means (mean CCS class change) were performed. was chosen as the metric for between-study heterogeneity. Publication bias was assessed by the inspection of funnel plots and Egger's regression test. We examined the risk of bias according to the Newcastle-Ottawa Scale.
RESULTS
From a total of 515 studies identified from the original search, 12 studies were finally included for data extraction. Based on their meta-analysis, we observed a high CSR procedural success (98%, 95% confidence interval (CI) 96 to 99%) with a low rate of periprocedural complications (6%, 95% CI 5 to 7%), while most patients exhibited an improvement by at least 1 CCS class (75%, 95% CI 66 to 83%) after the intervention. A significant proportion of patients demonstrated an improvement by at least 2 CCS classes (39%, 95% CI 34 to 45%), with a mean change of -1.24 CCS class (95% CI -1.40 to -1.08).
CONCLUSIONS
CSR is associated with high implantation success rates and significant improvements in angina symptoms for patients with refractory angina.
背景
难治性心绞痛是冠心病患者中常见的现象，常常给临床心脏病专家带来治疗挑战。已在这一方向探索了新的治疗方法，其中冠状动脉窦减压器（CSR）是研究最为广泛的方法之一。
方法
我们对评估CSR在难治性心绞痛患者中疗效的研究进行了系统的文献综述。感兴趣的主要终点是手术成功率以及根据加拿大心血管学会（CCS）分级至少改善一级的心绞痛情况。次要终点是围手术期不良事件发生率、至少改善2级CCS分级的情况以及CCS分级的平均变化。对比例（手术成功率、改善1级或2级、围手术期不良事件）或均值（CCS分级平均变化）进行随机效应荟萃分析。选择I²作为研究间异质性的指标。通过检查漏斗图和Egger回归检验评估发表偏倚。我们根据纽卡斯尔-渥太华量表检查偏倚风险。
结果
在最初检索到的515项研究中，最终纳入12项研究进行数据提取。基于荟萃分析，我们观察到CSR手术成功率较高（98%，95%置信区间（CI）96%至99%），围手术期并发症发生率较低（6%，95%CI 5%至7%），而大多数患者在干预后CCS分级至少改善1级（75%，95%CI 66%至83%）。相当一部分患者CCS分级至少改善2级（39%，95%CI 34%至45%），平均变化为-1.24级CCS分级（95%CI -1.40至-1.08）。
结论
对于难治性心绞痛患者，CSR与高植入成功率和心绞痛症状的显著改善相关。
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