Li Jiacheng, Lu Wei, Lin Lihong, Wu Jiawen, Cheng Guobing, Hu Qiang, Guo Yi
Department of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China.
Department of Nosocomial Infection Control, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China.
Front Cardiovasc Med. 2024 Nov 21;11:1511268. doi: 10.3389/fcvm.2024.1511268. eCollection 2024.
Peripheral artery disease (PAD) affects millions globally, causing significant morbidity. Traditional treatments like plain old balloon angioplasty (POBA) have limited success due to high restenosis rates. Drug-coated balloon angioplasty (DCBA) has emerged as a promising alternative, locally delivering antiproliferative drugs like paclitaxel to reduce restenosis. However, the clinical outcomes of DCBA compared to POBA remain inconsistent across various studies.
This umbrella meta-analysis aimed to compare the clinical outcomes of DCBA and POBA in PAD patients, synthesizing data from multiple meta-analyses to provide a more robust evidence base.
We conducted an umbrella meta-analysis following PRISMA guidelines, systematically reviewing Cochrane Library, Embase, PubMed, and Web of Science. Studies were included if they compared DCBA and POBA in PAD patients, focusing on primary outcomes such as target lesion revascularization (TLR), primary patency (PP), all-cause mortality (ACM), and amputation. Secondary outcomes included restenosis, late lumen loss (LLL), and major adverse events (MAE).
Sixteen meta-analyses were included. DCBA significantly reduced the risk of TLR (OR: 0.41, 95% CI: 0.34-0.49), PP was significantly higher in DCBA (OR: 2.05, 95% CI: 1.53-2.75), and restenosis was lower (OR: 0.46, 95% CI: 0.41-0.51). No significant differences were found in ACM or amputation risk between the two groups. Heterogeneity was moderate to high across most outcomes.
DCBA provides significant advantages over POBA in reducing TLR and restenosis while maintaining vessel patency. However, the effects on ACM and amputation remain inconclusive. Future research should focus on long-term safety and identifying which patient subgroups benefit most from DCBA.
https://www.crd.york.ac.uk/, PROSPERO [CRD42024591967].
外周动脉疾病（PAD）在全球影响着数百万人，导致严重的发病率。像普通球囊血管成形术（POBA）这样的传统治疗方法由于再狭窄率高，成功率有限。药物涂层球囊血管成形术（DCBA）已成为一种有前景的替代方法，它能局部递送如紫杉醇等抗增殖药物以降低再狭窄。然而，在各项研究中，DCBA与POBA相比的临床结果仍不一致。
这项汇总荟萃分析旨在比较DCBA和POBA在PAD患者中的临床结果，综合多项荟萃分析的数据以提供更有力的证据基础。
我们按照PRISMA指南进行了一项汇总荟萃分析，系统检索了Cochrane图书馆、Embase、PubMed和科学网。纳入的研究需比较DCBA和POBA在PAD患者中的情况，重点关注主要结局，如靶病变血运重建（TLR）、原发性通畅率（PP）、全因死亡率（ACM）和截肢。次要结局包括再狭窄、晚期管腔丢失（LLL）和主要不良事件（MAE）。
纳入了16项荟萃分析。DCBA显著降低了TLR风险（OR：0.41，95%CI：0.34 - 0.49），DCBA的PP显著更高（OR：2.05，95%CI：1.53 - 2.75），且再狭窄率更低（OR：0.46，95%CI：0.41 - 0.51）。两组在ACM或截肢风险方面未发现显著差异。大多数结局的异质性为中度到高度。
在降低TLR和再狭窄同时维持血管通畅方面DCBA比POBA具有显著优势。然而，对ACM和截肢的影响仍无定论。未来的研究应关注长期安全性，并确定哪些患者亚组从DCBA中获益最大。
https://www.crd.york.ac.uk/，PROSPERO [CRD42024591967]。
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