药物包膜球囊成形术治疗冠状动脉慢性全闭塞的疗效：系统回顾和荟萃分析。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2025-06-01 DOI:10.1016/j.carrev.2025.04.002

Filippo Luca Gurgoglione , Sara Malakouti , Bharat Khialani , Jasim Hasan , Jacinthe Khater , Giovanni Occhipinti , Davide Donelli , Bernardo Cortese

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引用次数: 0

摘要

慢性全闭塞（CTOs）的经皮冠状动脉介入治疗（PCI）与非cto病变的预后相比更差。在这种情况下，药物洗脱支架（DES）的植入是否是CTO再通成功后的基石治疗，最近的证据测试了基于DCB的PCI的临床表现，单独或与DES （DCB/DES混合入路）联合使用。我们的目的是对临床研究进行全面的、最新的系统回顾和汇总水平的荟萃分析，比较基于dbc的血管成形术与仅使用deb的血管成形术治疗冠状动脉CTOs的结果。进行了系统的检索，以确定所有比较基于dbc的血管成形术与仅使用des的血管成形术治疗冠状动脉CTOs的调查。主要终点是靶血管衰竭（TVF）的发生，这是心源性死亡、非致死性心肌梗死和靶血管重建术的复合结局。共有5项观察性研究（2087例患者）纳入分析。基于dbc的PCI组TVF发生率(0.45% （112/25045)vs. 0.76%（238/31336）人月，IRR = 0.56 [95% CI 0.28 ~ 1.10], I2 = 81%, p = 0.09）和心源性死亡发生率（0.05% vs. 0.10%人月，IRR = 0.55 [95% CI 0.27 ~ 1.10], I2 = 0%, p = 0.09）呈较低趋势，尽管观察到高度异质性。两组间其他终点无差异。在目前的荟萃分析中，与第二代DES PCI治疗冠状动脉CTOs相比，基于dbc的PCI与相似的结果相关。未来的随机对照试验将为DCB治疗冠状动脉CTOs的有效性提供更有力的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Efficacy of drug-coated balloon angioplasty for coronary chronic total occlusion: A systematic review and meta-analysis

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is associated with worse outcomes compared to non-CTO lesions. Whether the implantation of drug-eluting stents (DES) is the cornerstone treatment after successful recanalization of CTO, recent evidence tested the clinical performance of DCB-based PCI, alone or in concert with DES (hybrid DCB/DES approach), in this context. We aimed to conduct a comprehensive, up-to-date systematic review and summary-level meta-analysis of clinical studies comparing outcomes of DCB-based versus DEB-only angioplasty for coronary CTOs.

A systematic search was performed to identify all investigations comparing DCB-based versus DES-only angioplasty for coronary CTOs. The primary endpoint was the occurrence of target vessel failure (TVF), a composite outcome of cardiac death, nonfatal myocardial infarction and target vessel revascularization.

A total of 5 observational studies (2087 patients) were included in the analysis. The DCB-based PCI group experienced a trend towards a lower rate of TVF (0.45 % (112/25045) vs. 0.76 % (238/31336) person-months, IRR = 0.56 [95 % CI 0.28 to 1.10], I² = 81 %, p = 0.09) and cardiac death (0.05 % vs. 0.10 % person-months, IRR = 0.55 [95 % CI 0.27 to 1.10], I² = 0 %, p = 0.09), although a high extent of heterogeneity was observed. Other endpoints were not different between the two groups.

In the present meta-analysis, DCB-based PCI was associated with similar outcomes compared to second-generation DES PCI for the treatment of coronary CTOs. Future randomized controlled trials will provide more robust evidence on the effectiveness of DCB in treating coronary CTOs.

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来源期刊

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.