血管内超声指导药物洗脱支架置入术疗效的Meta分析

摘要

Objective To compare the curative effect between intravascular ultrasound (IVUS)-guided drug eluting stent (DES) implantation and traditional coronary angiography (CAG)-guided DES implantation. Methods The databases of PubMed, Cochrane Library, EMbase, CNKI and WanFang Database were retrieved with computer and quotation list of relevant literatures was retrieved manually for collecting eligible clinical studies. Results There were totally 10 randomized controlled trials (RCT) included involving 3459 cases, and 1718 in IVUS group and 1741 in CAG group. The results of Meta-analysis showed that IVUS-guided DES implantation decreased significantly the incidence of major adverse cardiac events (MACE,OR=0.58, 95%CI: 0.45~0.75, I2=0%,P<0.0001), target vessel revascularization rate (OR=0.61, 95%CI: 0.40~0.92,I2=0%,P=0.02) and target lesion revascularization rate (OR=0.59, 95%CI: 0.41~0.84,I2=0%,P=0.003) compared with CAG-guided DES implantation. The comparisons in in-stent thrombosis (P=0.07), cardiac mortality (P=0.13) and incidence of myocardial infarction (P=0.61) showed no significant difference between 2 groups, but the result in in-stent thrombosis was not stable.Conclusion Compared with traditional CAG-guided DES implantation, IVUS-guided DES implantation can significantly reduce the risks of MACE and revascularization, while its effect on in-stent thrombosis requires further confirmation in more studies with high quality.%目的：比较血管内超声（IVUS）和传统冠状动脉造影指导的药物洗脱支架（DES）置入术的疗效。方法计算机检索PubMed、Cochrane图书馆、EMBASE、中国知网及万方数据库，同时手工检索相关文献的引文目录，纳入满足要求的临床研究。结果最终纳入随机对照试验10项，总计患者3459例，其中IVUS组1718例，造影组1741例。Meta分析结果表明，相比传统冠状动脉造影，IVUS指导的DES置入术能显著降低主要心脏不良事件发生率（OR=0.58，95%CI：0.45~0.75，I2=0%，P＜0.0001）、靶血管血运重建率（OR=0.61，95%CI：0.40~0.92，I2=0%，P=0.02）及靶病变血运重建率（OR=0.59，95%CI：0.41~0.84，I2=0%，P=0.003）。两种指导DES置入的方案在支架内血栓形成（P=0.07）、心脏原因死亡率（P=0.13）、心肌梗死发生率方面无显著差异（P=0.61），但支架内血栓形成方面的结果缺乏稳定性。结论相比传统冠状动脉造影指导，IVUS指导下的DES置入可显著降低主要不良心脏事件和血运重建的风险，但支架内血栓形成方面的获益还需更多的高质量的研究来证明。