佐他莫司药物洗脱支架与雷帕霉素药物洗脱支架治疗冠心病临床疗效与安全性的Meta分析

目的比较佐他莫司药物洗脱支架（ZES）与雷帕霉素药物洗脱支架(SES)在经皮冠状动脉介入治疗术(PCI)中的临床疗效与安全性差异。方法检索Pubmed、Embase、Chocorane library、Science Direct、CNKI数据库、中国生物医学文献数据库以及相关网站(http://scholar.google.com/)，收集建库至2016年1月31日公开发表的有关ZES与SES疗效和安全性比较的随机对照实验（RCTs），按Chochrane系统评价手册对文献质量进行严格评价，对纳入的RCTs进行资料提取，采用RevMen 5.3软件进行Meta分析。结果共纳入9项RCTs，共6 672例患者，其中ZES组3 434例，SES组3 238例。结果显示：ZES组与SES组总病死发生率（RR=0.99，95%CI=0.83～1.19，P=0.93）、心源性猝死率（RR=0.86，95%CI=0.63～1.19，P=0.37）、主要不良心脏事件发生率（RR=1.05，95%CI=0.93～1.20，P=0.43）、心肌梗死发生率（RR=0.84，95%CI=0.68～1.02，P=0.08）、靶血管血运重建率（RR=1.19，95%CI=0.99～1.42，P=0.06）、支架内血栓发生率（RR=0.82，95%CI=0.46～1.46，P=0.50）差异无统计学意义，靶病变血运重建率（RR=1.49，95%CI=1.18～1.89，P=0.0008）差异有统计学意义。结论现有证据表明，两种药物洗脱支架治疗冠状动脉粥样硬化性心脏病（冠心病）的总死亡发生率、心源性猝死发生率、主要不良心脏事件发生率、心肌梗死发生率、靶血管血运重建率、支架内血栓发生率相似；与ZES相比，SES能明显降低支架术后靶病变血运重建的发生率，但敏感性分析显示该结果不稳定。

Curative effects and safety of zotarolimus eluting stents and sirolimus eluting stents on coronary heart disease: a meta analysis

ObjectiveTo compare the curative effects and safety of zotarolimus eluting stents (ZES) and sirolimus eluting stents (SES) after percutaneous coronary intervention(PCI). MethodsThe databases of Pubmed， Embase， Chocorane library， Science Direct， CNKI，Chinese Biological Medical Disc and related website such as http://scholar.google.com/ were retrieved with computer for collecting randomized controlled trials (RCTs) about the comparison in the curative effects and safety of ZES and SES published from inception to Jan 31， 2016. After critical appraisal for the literature quality using the Cochrane Reviewers Handbook， the eligible data of RCTs were extracted and given a meta analysis by applying RevMen 5.3 software. ResultsThere were nine RCTs identified (a total of 6 672 patients)， the treatment group had 3 434 cases and the control group had 3 238 cases. Meta analysis showed that there was no statistical difference between ZES group and SES group in the incidence of mortality (RR=0.99，95%CI=0.83 1.19，P=0.93)， cardiac mortality (RR=0.86，95%CI=0.63 1.19，P=0.37)， MACE (RR=1.05，95%CI=0.93 1.20，P=0.43)， myocardial infarction (RR=0.84， 95%CI=0.68 1.02，P=0.08)， target vessel revascularization (RR=1.19，95%CI=0.99 1.42，P=0.06) and stent thrombosis (RR=0.82，95%CI=0.46 1.46，P=0.50). There was statistically significant difference between two groups in the rate of target lesion revascularization (RR=1.49，95%CI=1.18 1.89，P=0.0008). ConclusionData showed that two kinds of drug eluting stents were similar in the incidence of mortality， cardiac mortality， MACE， MI， TVR and ST in the treatment of CHD. SES could significantly reduce the incidence of target lesion revascularization compared with ZES， but sensitivity analysis showed that above mentioned results were instable.