药物释放和裸金属支架的支架血栓形成:来自综合网络元分析的证据
Tullio Palmerini1, Giuseppe Biondi-Zoccai, Diego Della Riva
1Istituto di Cardiologia, Policlinico S Orsola, Bologna, Italy.
Lancet (London, England)
|March 27, 2012
概括
与裸金属支架相比,-常释放支架 (CoCr-EES) 在两年内显示出最低的支架血栓形成率. 这一发现表明,在减少血栓形成的支架选择中,存在潜在的范式转变.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 生物材料科学 生物材料科学
背景情况:
- 药物排泄支架 (DES) 与裸金属支架 (BMS) 在支架血栓形成方面的比较安全性仍然是一个关键的临床问题.
- 评估这些差异需要大量的患者队列,因为支架血栓的总体发病率很低.
研究的目的:
- 进行一个网络元分析,比较各种DES和BMS之间的支架血栓形成风险.
- 评估不同类型支架的安全性,重点关注明确的支架血栓形成率.
主要方法:
- 一个系统的网络元分析49个随机对照试验 (RCT) 涉及50844名患者.
- 包括在美国批准的比较DES和BMS的RCT,通过全面的数据库搜索 (Medline,Embase,Cochrane) 和会议记录确定.
主要成果:
- 与BMS (OR 0.23) 相比,-常释放支架 (CoCr-EES) 的1年明确支架血栓形成率明显较低.
- 与BMS (2年或0.35) 相比,CoCr-EES的血栓形成风险降低是早期 (30天) 观察到的,并且持续长达2年.
- 与其他DES相比,CoCr-EES还显示了较低的血栓形成率,包括帕克利塔塞尔释放支架和各种佐托利斯释放支架.
结论:
- 在随机研究中评估的支架中,CoCr-EES在两年内表现出最低的支架血栓形成率.
- 与BMS相比,CoCr-EES显著减少了支架血栓形成,这可能代表了干预性心脏病实践中的范式转变.
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