冠心病合并心房颤动患者经皮冠状动脉介入治疗术后抗栓策略选择的荟萃分析

Impact of different antithrombotic therapy strategy on prognosis in coronary heart disease patients combining with atrial fibrillation： a meta analysis

目的比较冠心病合并心房颤动（房颤）患者经皮冠状动脉介入治疗（PCI）术后三联抗栓治疗与双联抗血小板治疗策略对预后的影响。方法本研究为荟萃分析。通过计算机检索英文数据库Embase、Pubmed、Cochrane Central Register of Controlled Trials、Medline，中文数据库CBM、中国知网数据库、万方数据库、中国科技论文等在线电子数据库，手工检索国际上重要会议论文集，检索截止时间为2016年4月30日，语言选择英文和中文。按照Cochrane系统评价要求制定纳入、排除标准。主要研究终点为主要不良心血管事件（MACE）、缺血性卒中和主要出血事件。将纳入的患者分为三联（阿司匹林＋氯吡格雷＋华法林）抗栓治疗组和双联（阿司匹林＋氯吡格雷）抗血小板治疗组。根据标准制定检索策略，提取文献资料。运用RevMan5．3软件对文献质量偏倚风险进行评估，比较冠心病合并房颤患者PCI术后j联抗栓治疗与双联抗血小板治疗MACE、缺血性卒中和主要出血事件的发生率。结果共纳入随机对照试验12项，包含患者11353例，其中三联抗栓治疗组3486例，双联抗血小板治疗组7867例。分析发现，两组间MACE和缺血性卒中发生率差异均无统计学意义（MACE：OR=0．93，95％C／0．74～1．18，P〉0．05；缺血性卒中：OR=0．88，95％C／0．70～1．10，P=0．27），但三联抗栓治疗组患者主要出血事件的发生率明显高于双联抗血小板治疗组（OR：1．94，95％C／1．33～2．82，P=0．0006）。结论冠心病合并房颤患者PCI术后三联抗栓治疗与双联抗血小板治疗策略远期疗效相当，但出血风险较高。

Objective To evaluate the impact of various anticoagulation antiplatelet therapy strategies on the prognosis of patients with coronary heart disease combining with atrial fibrillation. Methods Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016. Trials published in English and Chinese language, which met the Cochrane system evaluation requirements were included and the inclusion and exclusion criteria were made based on Cochrane system evaluation requirements. The end point is the incident of major adverse cardiac events （MACE） , ischemic stroke and major bleeding events. The patients were randomly assigned into triple antithrombotic therapy （ aspirin ＋ clopidogrel ＋ warfarin ） group and dual antiplatelet therapy （aspirin ＋ elopidogrel） group. The collected full-text literatures underwent further quality assessment of the risks of bias using RevMan 5.3 software. Impact of various antithrombotie therapeutic strategies on the outcome of coronary heart disease patients combining with atrial fibrillation were evaluated. Results In this meta analysis, 12 randomized controlled trials with 11 353 patients were included. Among these patients, 3 486 patients received triple antithrombotic therapy and 7 867 patients received dual anti-platclet therapy. There was no significant difference in incidence rate of MACE （ OR = 0. 93,95% CI O. 74 - 1.18, P 〉 0. 05 ） and the incidence rate of isehemic stroke （ OR = 0. 88,95% CI 0. 70- 1.10, P = 0. 27 ） between the two patients groups. However, the incidence rate of major bleeding events in triple antithrombotic therapy group was twice higher than that in dual anti-platelet therapy （ OR = 1.94,95% CI 1.33 - 2. 82,P = O. 000 6）. Conclusion Compared with dual anti-platelet therapy strategy, coronary heart disease patients combining with atrial fibrillation who were treated by triple antithrombotic therapy strategy have the similar outcome on risk of ischemic stroke, but higher risk of major bleeding events.