依维莫司药物洗脱支架与西罗莫司药物洗脱支架治疗冠心病疗效的Meta分析

Curative effects of everolimus-eluting stent and sirolimus-eluting stent on coronary heart disease: a Meta-analysis

目的比较依维莫司药物洗脱支架(everolimus-eluting stent,EES)与西罗莫司药物洗脱支架(sirolimus-eluting stent,SES)治疗冠心病的疗效与安全性。方法计算机检索PubMed、MEDLINE、Cochrane Central Register of Controlled Trials、CNKI全文数据库,收集2007年1月至2012年12月公开发表的有关EES和SES疗效和安全性比较的随机对照试验(RCT),同时辅以手检纳入文献的参考文献。对文献质量进行严格评价后,符合要求的RCTs进行资料提取及采用RevMen5.1软件进行Meta分析。结果共纳入7项RCTs,Meta分析显示:EES组与SES组之间病死率(OR=0.98,95%CI:0.85～1.12,P=0.75)、心源性病死率(OR=1.05,95%CI:0.88～1.25,P=0.57)、靶病变血运重建(TLR)率(OR=0.92,95%CI:0.65～1.31,P=0.65)、主要心脏不良事件(MACE)发生率(OR=0.95,95%CI:0.77～1.18,P=0.66)、支架内血栓发生率(OR=0.80,95%CI:0.49～1.32,P=0.39)、支架内再狭窄发生率(OR=0.89,95%CI:0.26～3.04,P=0.85)均无统计学差异,但EES组心肌梗死发生率低于SES组(OR=0.66,95%CI:0.53～0.80,P<0.001)有统计学差异。结论在冠心病支架介入治疗中,EES能更显著降低支架术后的心肌梗死的发生率,但在病死率,心源性病死率,TLR、MACE、支架内血栓和支架内再狭窄的发生率方面,与SES相似。

Objective To compare the curative effect and safety of everolimus-eluting stent （ EES ） and sirolimus-eluting stent （ SES ） on coronary heart disease （ CHD ） . Methods The databases of PubMed, MedLine, CENTRAL and CNKI were retrieved with computers for collecting randomized controlled trials （ RCT ） about the comparison in the curative effect and safety of EES and SES published from Jan. 2007 to Dec. 2012. At the same time, the reference materials of included literature were retrieved manually. After rigorous evaluation on literature quality, the eligible data of RCT was extracted and given a Meta-analysis by applying RevMenS.1 software. Results There were totally 7 RCT included, and the results of Meta-analysis showed that between EES group and SES group, the rate of mortality （ OR=0.98, 95%C1： 0.85-1.12, P=0.75 ） , cardiac mortality （ OR= 1.05, 95%C1： 0.88-1.25, P=0.57 ） and target lesion revascularization （ TLR, OR=0.92, 95%CI： 0.65-1.31, P=0.65 ） , and the incidence major adverse cardiovascular events （ MACE, OR=0.95, 95%CI： 0,77-1.18, P=0.66 ） , instent thrombosis （ OR=0.80, 95%CI： 0.49-1.32, P=0.39 ） and in-stent restenosis （ OR=0.89, 95%CI： 0.26-3.04, P=0.85 ） all had no statistical difference, while the incidence of myocardial infarction was lower in EES group than that in SES group （ OR=0.66, 95%CI： 0.53-0.80, P〈0.001 ） . Conclusion In the treatment of CHD with stent implantation, EES ean significantly reduce the incidence of myocardial infarction, but is similar to SES in the rate of mortality, cardiac mortality and TLR, and the incidence MACE, in-stent thrombosis and in-stent restenosis.