生物可吸收涂层和永久涂层药物支架治疗冠状动脉粥样硬化性心脏病的Meta分析

摘要 背景：生物可吸收涂层药物支架和永久涂层药物支架均广泛应用于冠状动脉粥样硬化性心脏病介入治疗中，由于支架架构、支架药物、药物载体上的差异，多个研究对两种支架疗效和安全性的比较结果不完全一致。 目的：比较生物可吸收涂层药物支架和永久涂层药物支架在冠状动脉粥样硬化性心脏病介入治疗的临床结果，评价两类支架在疗效和安全性上的差异。 方法：检索Medline(1966-01/2010-07)、Embase(1980-01/2010-07)、Cochrane library(2010-07)、中国生物医学文献数据库(CBM, 1990-01/2010-07)及相关参考文献，收集比较生物可吸收涂层药物支架与永久涂层药物支架的对照研究，采用Cochrane的随机方法学评价文献质量，应用RevMan5.0软件进行Meta分析。 结果与结论：纳入10个对照研究，共纳入4 391例患者，其中生物可吸收涂层药物支架组2 429例，永久涂层药物支架组1 962例。Meta分析结果显示，生物可吸收涂层药物支架用于冠状动脉粥样硬化性心脏病患者，支架置入后6~12个月内心脏主要不良事件、靶血管血运重建、心脏性死亡、再发心肌梗死、支架内血栓形成和支架内再狭窄与永久涂层药物支架组差异无显著性意义。但生物可吸收涂层药物支架内晚期管腔丢失明显小于永久涂层药物支架组(P < 0.05)。提示生物可吸收涂层药物支架用于治疗冠状动脉粥样硬化性心脏病安全、有效，并不劣于永久涂层药物支架，且可能在减轻冠状动脉支架置入治疗后内膜过度增生方面更具优势。

Bioabsorbable drug-eluting stents versus durable drug-eluting stents for treatment of coronary atherosclerotic heart disease: A Meta-analysis

Abstract BACKGROUND: Bioabsorbable and durable drug-eluting stents are widely used in coronary atherosclerotic heart disease intervention, due to the variations in the stent structure, drugs and drug carrier, several studies on the efficacy and safety of the two stents is not entirely consistent. OBJECTIVE: To compare the efficacy and safety of bioabsorbable drug-eluting stents with durable drug-eluting stents in treating coronary atherosclerotic heart disease patients undergoing percutaneous coronary intervention. METHODS: A computer-aided search of MEDLINE (January 1966 to July 2010), EMBASE (January 1980 to July 2010), Cochrane library (July 2010), Chinese Biomedical Databases (January 1990 to July 2010) was conducted to collected the control studies related with bioabsorbable drug-eluting stents versus durable drug-eluting stents for treatment of coronary heart disease. The methodological quality of included studies was assessed according to Cochrane handbook 5.1.2. Statistical analysis was performed using RevMan 5.0 software. RESULTS AND CONCLUSIONS: Data from 10 controlled trials were included with a total of 4 391 cases, including 2 429 cases undergoing bioabsorbable drug-eluting stents and 1 962 cases undergoing durable drug-eluting stents. Meta analysis indicated no significance differences in incidence of major cardiac events, in-stent restenosis, target lesion revascularization, cardiac death, recurrent myocardial infarction and in-stent thrombosis between two groups within 6-12 months after the stent implantation. But the in-stent late loss was significantly lower in the bioabsorbable drug-eluting stent group compared with the durable drug-eluting stent group (P < 0.05). Bioabsorbable drug-eluting stents and durable drug-eluting stents are effective and safe in treating coronary atherosclerotic heart disease. Bioabsorbable drug-eluting stents are not inferior to durable stents and have a definite advantage in suppressing the neointimal hyperplasia.