背景:新一代超薄撑杆支架与短期内经皮冠状动脉介入治疗(PCI)患者靶病变衰竭(TLF)的发生率较低相关。然而,其对不同心血管结局的长期影响尚不清楚.
目的:我们的目的是确定新一代超薄支柱支架与标准厚度第二代药物洗脱支架(DES)对冠状动脉疾病血运重建长期结局的影响.
方法:我们搜索了PubMed,WebofScience,Cochrane图书馆数据库,和Scopus用于随机对照试验(RCT)和注册,比较新一代超薄支柱(<70mm)和较厚支柱(>70mm)DES,以评估长达5年的心脏保护作用。主要结果是TLF,心脏死亡的复合物,靶血管心肌梗死(TVMI)或靶病变血运重建(TLR)。次要结局包括TLF的组成部分,支架内血栓形成(ST),将全因死亡汇总为两组之间从基线到终点的标准化平均差.
结果:在这项分析中,我们纳入了19项随机对照试验和2项前瞻性研究(103,101例患者)。在TLF≥1年时,对主要结局的总体影响有利于第二代超薄撑杆支架。≥2年,≥3年(P值=0.01,95%CI[0.75,0.96]),P值=0.003,95%CI[0.77,0.95]),P值=0.007,95%CI[0.76,0.96]),分别。然而,当我们在≥5年比较两组时,没有报告TLF方面的益处(P值=0.21),95%CI[0.85,1.04])。主要和次要结局的一些报告成分,比如TLR,靶血管血运重建(TVR),和TVMI,显示与TLF结果相同的模式。
结论:超薄支柱DES在长达3年的时间内对较厚的支柱支架显示出有益的效果。然而,在5年的随访中,超薄支柱在TLF方面没有差异,TLR,TVR,和TVMI与标准厚度DES相比,以患者为导向的复合终点(POCE)的风险相似,MI,ST,心脏死亡,和全因死亡率。
BACKGROUND: Newer generation ultrathin strut stents are associated with less incidence of target lesion failure (TLF) in patients undergoing percutaneous coronary intervention (PCI) in the short term. However, its long-term effect on different cardiovascular outcomes remains unknown.
OBJECTIVE: We aim to identify the effects of newer-generation ultrathin-strut stents vs. standard thickness second-generation drug-eluting stents (
DES) on long-term outcomes of revascularization in coronary artery disease.
METHODS: We searched PubMed, Web of Science, Cochrane Library databases, and Scopus for randomized controlled trials (RCTs) and registries that compare newer-generation ultrathin-strut (< 70 mm) with thicker strut (> 70 mm)
DES to evaluate cardioprotective effects over a period of up to 5 years. Primary outcome was TLF, a composite of cardiac death, target vessel myocardial infarction (TVMI) or target lesion revascularization (TLR). Secondary outcomes included the components of TLF, stent thrombosis (ST), and all-cause death were pooled as the standardized mean difference between the two groups from baseline to endpoint.
RESULTS: We included 19 RCTs and two prospective registries (103,101 patients) in this analysis. The overall effect on the primary outcome was in favor of second-generation ultrathin struts stents in terms of TLF at ≥ 1 year, ≥ 2 years, and ≥ 3 years (P value = 0.01, 95% CI [0.75, 0.96]), P value = 0.003, 95% CI [0.77, 0.95]), P value = 0.007, 95% CI [0.76, 0.96]), respectively. However, there was no reported benefit in terms of TLF when we compared the two groups at ≥ 5 years (P value = 0.21), 95% CI [0.85, 1.04]). Some of the reported components of the primary and secondary outcomes, such as TLR, target vessel revascularization (TVR), and TVMI, showed the same pattern as the TLF outcome.
CONCLUSIONS: Ultrathin-strut
DES showed a beneficial effect over thicker strut stents for up to 3 years. However, at the 5-year follow-up, the ultrathin strut did not differ in terms of TLF, TLR, TVR, and TVMI compared with standard-thickness
DES, with similar risks of patient-oriented composite endpoint (POCE), MI, ST, cardiac death, and all-cause mortality.