药物涂层球囊与普通球囊血管成形术用于冠状动脉分叉病变分支处理的系统评价与Meta分析
Drug-Coated Balloons vs. Plain Balloon Angioplasty for Side Branch Management in Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis.
作者信息
Özbay Mustafa Bilal, Değirmen Serhat, Güllü Ayşenur, Nriagu Bede Nnaemeka, Özen Yasin, Yayla Çağrı
机构信息
Department of Medicine, Penn Medicine Princeton Medical Center, Plainsboro, NJ, USA.
Department of Medicine, Metropolitan Hospital Center, New York, NY, USA.
出版信息
Anatol J Cardiol. 2025 May 23;29(6):272-9. doi: 10.14744/AnatolJCardiol.2025.5296.
BACKGROUND
Bifurcation lesions pose unique challenges during percutaneous coronary intervention (PCI) and are associated with suboptimal outcomes. The standard approach involves provisional stenting of the main branch (MB) with plain balloon angioplasty (BA) for compromised side branches (SBs). It remains unclear whether drug-coated balloon (DCB) or plain balloon angioplasty pose a better strategy to treat SB in bifurcation lesions. This systematic review and meta-analysis compared the efficacy of DCB versus BA in managing SBs of bifurcation lesions.
METHODS
MEDLINE, Cochrane, and EMBASE databases were searched for randomized controlled trials (RCTs) comparing DCB and BA for treating bifurcation lesions. Outcomes included SB late lumen loss (LLL), major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), and target lesion revascularization (TLR).
RESULTS
Five RCTs were included, encompassing 1,255 patients, of whom 628 (50.4%) underwent DCB angioplasty; 946 (75.4%) were male, and the mean age was 63.5 years. Drug-coated balloons significantly reduced MI risk (risk ratio [RR] = 0.56, 95% CI: 0.35-0.88, P = .010). DCB use resulted in similar LLL in the SB compared with BA (mean difference (MD) = -0.12 mm, 95% CI: -0.24-0.01, P = .070). No significant differences were observed in TLR (RR = 1.19, 95% CI: 0.45-3.14, P = .720), MACE (RR = 0.70, 95% CI: 0.48-1.02, P = .070), and all-cause mortality (RR = 2.35, 95% CI: 0.61-9.00, P = .210).
CONCLUSION
In this meta-analysis of RCTs, DCB significantly reduced MI without affecting LLL, TLR, MACE, and all-cause mortality compared with BA in the SB of bifurcation lesions.
背景
分叉病变在经皮冠状动脉介入治疗（PCI）过程中带来独特挑战，且与欠佳的治疗结果相关。标准方法是对主支（MB）进行临时支架置入，并对受累的分支（SB）行普通球囊血管成形术（BA）。药物涂层球囊（DCB）或普通球囊血管成形术哪种是治疗分叉病变中分支的更佳策略仍不明确。本系统评价和荟萃分析比较了DCB与BA在处理分叉病变分支方面的疗效。
方法
检索MEDLINE、Cochrane和EMBASE数据库，查找比较DCB和BA治疗分叉病变的随机对照试验（RCT）。结局指标包括分支晚期管腔丢失（LLL）、主要不良心血管事件（MACE）、全因死亡率、心肌梗死（MI）和靶病变血运重建（TLR）。
结果
纳入5项RCT，共1255例患者，其中628例（50.4%）接受DCB血管成形术；946例（75.4%）为男性，平均年龄63.5岁。药物涂层球囊显著降低MI风险（风险比[RR]=0.56，95%CI：0.35 - 0.88，P = 0.010）。与BA相比，DCB用于分支时LLL相似（平均差[MD]= - 0.12mm，95%CI： - 0.24 - 0.01，P = 0.070）。在TLR（RR = 1.19，95%CI：0.45 - 3.14，P = 0.720）、MACE（RR = 0.70，95%CI：0.48 - 1.02，P = 0.070）和全因死亡率（RR = 2.35，95%CI：0.61 - 9.00，P = 0.210）方面未观察到显著差异。
结论
在这项RCT的荟萃分析中，与BA相比，DCB在分叉病变分支中显著降低MI，且不影响LLL、TLR、MACE和全因死亡率。
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