药物洗脱支架置入术后支架内再狭窄的危险因素及发生率：一项系统评价和Meta分析
Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis.
作者信息
Liu Birong, Li Meng, Liu Jia, Xie Lihua, Li Jiaqi, Liu Yong, Niu Chaofeng, Xiao Di, Li Jingen, Zhang Lijing
机构信息
Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, China.
Department of Cardiovascular Medicine, Xi'an Hospital of Traditional Chinese Medicine, 710001 Xi'an, Shaanxi, China.
出版信息
Rev Cardiovasc Med. 2024 Dec 24;25(12):458. doi: 10.31083/j.rcm2512458. eCollection 2024 Dec.
BACKGROUND
Despite significant reductions in in-stent restenosis (ISR) incidence with the adoption of drug-eluting stents (DES) over bare metal stents (BMS), ISR remains an unresolved issue in the DES era. The risk factors associated with DES-ISR have not been thoroughly analyzed. This meta-analysis aims to identify the key factors and quantify their impact on DES-ISR.
METHODS
We conducted comprehensive literature searches in PubMed, EMBASE, Cochrane, and Web of Science up to 28 February 2023, to identify studies reporting risk factors for DES-ISR. Meta-analysis was performed on risk factors reported in two or more studies to determine their overall effect sizes.
RESULTS
From 4357 articles screened, 17 studies were included in our analysis, evaluating twenty-four risk factors for DES-ISR through meta-analysis. The pooled incidence of DES-ISR was approximately 13%, and significant associations were found with seven risk factors. Ranked risk factors included diabetes mellitus (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.14-1.87), stent length (OR: 1.026; 95% CI: 1.003-1.050), number of stents (OR: 1.62; 95% CI: 1.11-2.37), involvement of the left anterior descending artery (OR: 1.56; 95% CI: 1.25-1.94), lesion length (OR: 1.016; 95% CI: 1.008-1.024), medical history of myocardial infarction (OR: 1.79; 95% CI: 1.12-2.86) and previous percutaneous coronary intervention (OR: 1.97; 95% CI: 1.53-2.55). Conversely, a higher left ventricular ejection fraction was identified as a protective factor (OR: 0.985; 95% CI: 0.972-0.997).
CONCLUSIONS
Despite advancements in stent technology, the incidence of ISR remains a significant clinical challenge. Our findings indicate that patient characteristics, lesion specifics, stent types, and procedural factors all contribute to DES-ISR development. Proactive strategies for early identification and management of these risk factors are essential to minimize the risk of ISR following DES interventions.
THE PROSPERO REGISTRATION
CRD42023427398, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=427398.
背景
尽管采用药物洗脱支架（DES）后支架内再狭窄（ISR）的发生率相较于裸金属支架（BMS）有显著降低，但在DES时代，ISR仍是一个未解决的问题。与DES-ISR相关的危险因素尚未得到充分分析。本荟萃分析旨在确定关键因素并量化它们对DES-ISR的影响。
方法
我们在PubMed、EMBASE、Cochrane和Web of Science中进行了全面的文献检索，截至2023年2月28日，以识别报告DES-ISR危险因素的研究。对两项或更多研究中报告的危险因素进行荟萃分析，以确定其总体效应大小。
结果
在筛选的4357篇文章中，17项研究纳入了我们的分析，通过荟萃分析评估了24个DES-ISR的危险因素。DES-ISR的合并发生率约为13%，并发现与7个危险因素存在显著关联。排序后的危险因素包括糖尿病（优势比[OR]：1.46；95%置信区间[CI]：1.14 - 1.87）、支架长度（OR：1.026；95% CI：1.003 - 1.050）、支架数量（OR：1.62；95% CI：1.11 - 2.37）、左前降支受累（OR：1.56；95% CI：1.25 - 1.94）、病变长度（OR：1.016；95% CI：1.008 - 1.024）、心肌梗死病史（OR：1.79；95% CI：1.12 - 2.86）和既往经皮冠状动脉介入治疗（OR：1.97；95% CI：1.53 - 2.55）。相反，较高的左心室射血分数被确定为保护因素（OR：0.985；95% CI：0.972 - 0.997）。
结论
尽管支架技术有所进步，但ISR的发生率仍然是一个重大的临床挑战。我们的研究结果表明，患者特征、病变细节、支架类型和手术因素均对DES-ISR的发生有影响。对这些危险因素进行早期识别和管理的积极策略对于降低DES介入治疗后ISR的风险至关重要。
PROSPERO注册号：CRD42023427398，https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=427398
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