依维莫司洗脱支架与西罗莫司洗脱支架治疗冠心病的Meta分析

Meta analysis of everolimus-eluting stents versus sirolimus-eluting stents in the treatment of coronary artery disease

摘要:

目的：比较依维莫司洗脱支架（everolimus-eluting stents，EES）与西罗莫司洗脱支架（sirolimus-eluting stents，SES）治疗冠心病的有效性和安全性。方法：计算机检索PubMed、EMbase、Cochrane 图书馆、CNKI全文数据库，收集2000－2012年公开发表的关于EES和SES比较治疗冠心病的疗效和安全性的随机对照试验（randomized controlled trials，RCTs）。对纳入的研究进行资料提取和方法学质量评价后，采用RevMan 5.0 软件进行Meta分析。结果：共纳入10个RCTs，12 937例患者，其中 EES组6 378例，SES组6 559例，Jadad评分均≥3分。Meta分析结果显示，EES组在明确的支架内血栓形成率方面明显低于SES组（OR=0.47，95%CI=0.26~0.85，P=0.01），而在靶病变血运重建率（OR=0.85，95%CI=0.70~1.03，P=0.11）、靶血管血运重建率（OR=0.92，95%CI=0.77~1.09，P=0.33）、心源性死亡率（OR=0.91，95%CI＝0.69～1.20，P=0.52）、主要心脏不良事件（OR=0.89，95%CI ＝0.78～1.02，P=0.09）以及心肌梗死再发生率方面（OR=0.95，95%CI＝0.75～1.19，P=0.63），2组差异无统计学意义。结论：相比于SES，EES可以有效降低明确的支架内血栓发生率。

Abstract:

Objective：To systematically evaluate the efficacy and safety of everolimus-eluting stents（EES） versus sirolimus-eluting stents（SES） in the treatment of patients with coronary artery disease undergoing percutaneous coronary intervention. Methods：Databas－es such as PubMed，EMbase，Cochrane Library and CNKI were searched to collect all the randomized controlled trials（RCTs） of EES versus SES in patients with coronary artery disease from 2000 to 2012. After the data extraction and methodological quality evaluation，Meta analysis was conducted with RevMan 5.0 software. Results：A total of 10 RCTs were included. Among 12 937 patients involved，6 378 were in EES group while the other 6 559 were in SES group. Results of Meta analysis showed that EES was superior to SES in reducing definite stent thrombosis rates（OR=0.47，95%CI=0.26 to 0.85，P=0.01）. In contrast，there were no significant differences between EES and SES in target-lesion revascularization rates（OR=0.85，95%CI=0.70 to 1.03，P=0.11），target-vessel revasculariza－tion rates（OR=0.92，95%CI=0.77 to 1.09，P=0.33），cardiac death rates（OR=0.91，95%CI=0.69 to 1.20，P=0.52），incidences of major adverse cardiac event（OR=0.89，95%CI=0.78 to 1.02，P=0.09） and recurrence rates of myocardial infarction（OR=0.95，95%CI=0.75 to 1.19，P=0.63）. Conclusions：EES is more effective than SES in reducing the rate of definite stent thrombosis.