背景:药物涂层球囊(DCB)是冠状动脉疾病的既定策略。然而,新一代药物洗脱支架(DES)推荐用于急性心肌梗死(AMI)患者的冠状动脉血运重建.我们的目的是全面评估DCB在接受PCI的AMI患者中的疗效。
方法:我们搜索了WOS,PubMed,Scopus,和CochraneCENTRAL至2023年3月,用于比较接受PCI的AMI患者的DCB和DES的研究。我们使用随机效应模型来比较主要不良心脏事件(MACE),心脏死亡,全因死亡,心肌梗塞,靶病变血运重建(TLR),支架内血栓形成,晚期管腔损失(LLL),两组之间的最小管腔直径(MLD)。
结果:纳入了13项研究,包括2644名患者。合并OR显示DCB在MACE方面相对于DES非劣效性(OR=0.89,95%CI[0.57至1.40],p=0.63)。当我们将MACE定义为心脏死亡的复合物时,MI,和TLR;合并的OR比DES更喜欢DCB(OR=0.50,95%CI[0.28至0.9],p=0.02)。此外,就全因死亡率而言,DCB不亚于DES(OR=0.88,95%CI:0.43至1.8,p=0.73),心脏死亡率,(OR=0.59,95%CI:0.22至1.56,p=0.29),MI(OR=0.88,95%CI:0.34至2.29,p=0.79),支架内血栓形成(OR=1.21,95%CI:0.35~4.23,p=0.76),TLR(OR=0.9,95%CI:0.43至1.93,p=0.8),LLL(MD=-0.6,95%CI:-0.3至0.19,p=0.64),或MLD(MD=-0.4,95%CI:-0.33至0.25,p=0.76)。
结论:我们的荟萃分析表明,在AMI患者的PCI设置中,DCB干预并不劣于DES,并可作为AMI的可行策略。
■CRD42023412757。
Drug-coated balloons (DCBs) are an established strategy for coronary artery disease. However, the new generation drug-eluting stent (
DES) is recommended for patients with Acute myocardial infarction (AMI) for coronary artery revascularization. Our aim is to provide a comprehensive appraisal of the efficacy of DCBs in patients with AMI undergoing PCI.
We searched the WOS, PubMed, Scopus, and Cochrane CENTRAL till March 2023, for studies that compared DCBs versus
DES in patients with AMI undergoing PCI. We used a random-effects model to compare major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, Late lumen Loss (LLL), and minimum lumen diameter (MLD) between the two groups.
Thirteen studies comprising 2644 patients were included. The pooled OR showed non-inferiority of DCB over
DES in terms of MACE (OR = 0.89, 95% CI [0.57 to 1.40], p = 0.63). When we defined MACE as a composite of cardiac death, MI, and TLR; the pooled OR favored DCB over
DES (OR = 0.50, 95% CI [0.28 to 0.9], p = 0.02). Moreover, DCB was not inferior to
DES in terms of all-cause mortality (OR = 0.88, 95% CI: 0.43 to 1.8, p = 0.73), cardiac mortality, (OR = 0.59, 95% CI: 0.22 to 1.56, p = 0.29), MI (OR = 0.88, 95% CI: 0.34 to 2.29, p = 0.79), stent thrombosis (OR = 1.21, 95% CI: 0.35 to 4.23, p = 0.76), TLR (OR = 0.9, 95% CI: 0.43 to 1.93, p = 0.8), LLL (MD = -0.6, 95% CI: -0.3 to 0.19, p = 0.64), or MLD (MD = -0.4, 95% CI: -0.33 to 0.25, p = 0.76).
Our meta-analysis indicated that DCB intervention was not inferior to DES in the PCI setting in patients with AMI, and can be recommended as a feasible strategy in AMI.
CRD42023412757.