支架策略：内皮祖细胞涂层支架与西罗莫司洗脱支架的配对荟萃分析。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-11-02 DOI:10.1016/j.amjsurg.2024.116055

Srishti Kohli , Daksh Kohli , Raghav Gupta

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引用次数: 0

摘要

背景：针对西罗莫司洗脱支架（SES）的局限性，开发了内皮祖细胞（EPC）捕获支架，以增强内皮修复并降低支架血栓形成的风险。本研究旨在比较 EPC 支架与 SES 在经皮冠状动脉介入治疗（PCI）患者中的安全性和有效性：我们按照 PRISMA 指南对使用西罗莫司洗脱支架 (SES) 与使用 EPC 支架进行 PCI 治疗的患者进行了一项荟萃分析，并确认了 8 项临床试验，这些临床试验的患者均接受了 PCI 治疗，并报告了靶病变失败 (TLF)、支架血栓形成和血管再通等结果。采用随机效应模型计算相对风险，并用I^2统计量评估异质性：与 SES 相比，EPC 组的 TLF（RR = 1.28）、MI（RR = 1.10）和心源性死亡（RR = 1.19）发生率更高，但这些差异并无统计学意义。EPC组的血管再通率明显高于TVR（RR = 1.60）和TLR（RR = 2.20），而支架血栓形成率较低（RR = 0.93）：这项EPC研究的结果表明，虽然EPC支架在血管再通和降低支架血栓形成方面显示出前景，但它们也与较高的不良事件发生率相关。EPC的效用，尤其是巨大的再内皮化，可能具有利基应用价值，但由于与SES相比仍缺乏明显优势，其全部潜力有待更严格的试验来实现。

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Stent strategies: Endothelial progenitor cell coated stents vs sirolimus eluting stents in a pairwise meta-analysis

Background

Endothelial progenitor cells (EPCs) capturing stents were developed to enhance endothelial repair and reduce the risk of stent thrombosis, addressing limitations of Sirolimus-Eluting Stents (SES). This study aims to compare the safety and efficacy of EPC stents versus SES in patients undergoing percutaneous coronary intervention (PCI).

Methods

We performed a meta-analysis following PRISMA guidelines in patients undergoing PCI treated with Sirolimus eluting stent (SES) vs the use of EPC stents and recognized 8 clinical trials with patients undergoing PCI and reporting outcomes such as Target Lesion Failure (TLF), stent thrombosis, and revascularisation. Relative risks were calculated using a random effects model and heterogeneity was assessed with I^2 statistics.

Results

The EPC group showed higher incidence of TLF (RR = 1.28), MI(RR = 1.10), and cardiac death (RR = 1.19) compared to SES, though these differences were not statistically significant. Revascularisation rates were significantly higher in EPC group with TVR (RR = 1.60) and TLR(RR = 2.20) while stent thrombosis was lower (RR = 0.93).

Conclusion

The results of this EPC study reveals that while EPC stents show promise in revascularisation and lowering stent thrombosis, they are also associated with higher incidence of adverse events. The utility of EPC, especially vast reendothelialization, may have niche applications but their full potential can be realized with more rigorous trials as a clear advantage over SES remains lacking.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.