药物包被球囊与药物洗脱支架治疗新生冠状动脉疾病：随机对照试验的荟萃分析

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2024-12-19 eCollection Date: 2024-12-01 DOI:10.31083/j.rcm2512446

Jialong Niu, Kexin Wang, Wenjie Wang, Yixuan Liu, Jiaxin Yang, Yan Sun, Furong Wang, Wen Gao, Hailong Ge

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引用次数: 0

摘要

背景：由于新一代药物洗脱支架（DES）的局限性，提倡使用药物包被球囊（DCB）的非支架治疗现在引起了极大的兴趣。在这里，我们进行了一项荟萃分析，以证明DCB在治疗新发冠状动脉疾病（CAD）方面是否比DES更有效和更安全。方法：我们检索PubMed， Embase， Cochrane Library和Web of Science以获得比较DCB与DES治疗新生CAD的高质量试验。主要终点是靶病变血运重建术（TLR），次要终点是病变内晚期管腔丧失（LLL）、全因死亡、心肌梗死和二元再狭窄。结果：我们从7个随机临床试验中入组了1661例患者。与DES组相比，DCB组病变内LLL的MD （mean difference）显著降低（MD -0.19, 95% CI -0.23 ~ -0.16, p < 0.00001, I2 = 0%）。DCB组在小血管病变（SVD）中表现出优势（MD -0.21, 95% CI -0.34 ~ -0.08, p = 0.001）。结论：与DES组相比，DCB组表现出更低的病灶内LLL，并且DCB在其他终点（包括SVD亚组）并不逊于DES。因此，据我们所知，DCB对于新生CVD和SVD的疗效并不亚于DES。CVD患者的DCB需要进一步的大型和长期临床试验来证明其长期疗效。普洛斯彼罗注册：CRD42021268965， https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268965。

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Drug-Coated Balloons versus Drug-Eluting Stents for the Treatment of De Novo Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials.

Background: Because of the limitations in new-generation drug-eluting stents (DES), treatments advocating for non-stents with a drug-coated balloon (DCB) is now of great interest. Here, we conducted a meta-analysis to testify whether a DCB was more effective and safer than a DES in treating de novo coronary artery disease (CAD).

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science to obtain high-quality trials comparing DCB with DES for the treatment of de novo CAD. The primary endpoint was target lesion revascularization (TLR), and the secondary endpoints were in-lesion late lumen loss (LLL), all-cause death, myocardial infarction and binary restenosis.

Results: We enrolled 1661 patients from seven randomized clinical trials. Compared with the DES group, the MD (mean difference) of in-lesion LLL was significantly lower in the DCB group (MD -0.19, 95% CI -0.23 to -0.16, p < 0.00001, I² = 0%). The DCB group showed superiority in small vessel disease (SVD) in in-lesion LLL (MD -0.21, 95% CI -0.34 to -0.08, p = 0.001).

Conclusions: The DCB group exhibited a lower in-lesion LLL compared to the DES group, and DCB was not inferior to DES in other endpoints, including in the SVD subgroup. Hence, to our knowledge, DCB is non-inferior to DES for de novo CVD and SVD. DCB in patients with CVD needs further large and long-term clinical trials to demonstrate its long-term efficacy.

The prospero registration: CRD42021268965, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268965.

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.