佐他莫司药物洗脱支架与西罗莫司药物洗脱支架治疗冠心病有效性与安全性的meta分析

Efficacy and Safety of Zotarolimus-eluting Stents and Sirolimus-eluting Stents in Treatment of Coronary Heart Disease: a Meta-analysis

目的评价佐他莫司药物洗脱支架(zotarolimus-eluting stent,ZES)与西罗莫司药物洗脱支架(sirolimuseluting stent,SES)治疗冠心病的有效性与安全性。方法计算机检索中国生物医学文献数据库、中国期刊全文数据库、维普数据库及万方数据库建库至2015年3月,Pubmed 1990年—2015年3月及Cochrane Library 2015年3期与ZES和SES治疗冠心病相关的随机对照研究文献,根据纳入及排除标准筛选文献,采用Jadad改良法制定的量表对文献质量进行评价,应用Rev Man 5.2统计软件进行meta分析。结果本研究最终纳入文献11篇7171例。meta分析结果显示ZES组与SES组心源性死亡发生率[RR=0.71,95%可信区间(CI)(0.42,1.20),P=0.20]、主要不良心脏事件发生率[RR=1.20,95%CI(0.87,1.65),P=0.28]及确定或可能支架内血栓发生率[RR=0.80,95%CI(0.37,1.75),P=0.58)]比较差异均无统计学意义;但ZES组靶病变血运重建率[RR=2.02,95%CI(1.25,3.26),P=0.004]和靶血管血运重建率[RR=1.62,95%CI(1.05,2.52),P=0.03]高于SES组,心肌梗死发生率[RR=0.77,95%CI(0.60,0.99),P=0.04]低于SES组,差异均具有统计学意义。结论在冠心病支架介入治疗中,ZES较SES能显著增加靶病变血运重建率和靶血管血运重建率、降低心肌梗死发生率,但心源性死亡发生率、主要不良心脏事件发生率及确定或可能支架内血栓发生率与SES相似。

Objective To assess the efficacy and safety of Zotarolimus-eluting stent （ZES） and Sirolimus-eluting stent （SES） in treatment of coronary heart disease （CHD）.Methods Related papers about ZES and SES were retrieved in CJFD, CBM, VIP, WanFang databases from establishment to March 2015, PubMed database from 1990 to March 2015 and Cochrane Library in March 2015 for randomized controlled trials （RCTs）.The papers were screened and extracted by internalizing and evacuating, and the qualities of papers were evaluated by using Jadad reforming scale, and then meta analysis was performed by using Rev Man 5.2 software.Results A total of 11 papers （7171 cases） were included in this study.Meta-analysis result showed that there were no significant differences in incidence rate of cardiac death [RR=0.71, 95%CI（0.42, 1.20）, P=0.20], major adverse cardiovascular events [RR=1.20, 95%CI（0.87, 1.65）, P=0.28] and definite or probable incidence rate of stent thrombosis [RR=0.80, 95%CI（0.37, 1.75）, P=0.58] between ZES and SES groups.In ZES group, revascularization rate of target lesion [RR=2.02, 95%CI（1.25, 3.26）, P=0.004] and revascularization rate of target vessel [RR=1.62, 95%CI（1.05, 2.52）, P=0.03] were significantly higher, while incidence rate of myocardial infarction （MI） events [RR=0.77, 95%CI （0.60, 0.99）, P=0.04] was significantly lower than those in SES group.Conclusion In CHD treatment with stent implantation, ZES can significantly reduce incidence rate of MI events, increase revascularization rates of target lesion and target vessel compared with those by SES, but ZES has similar to SES in incidence rates of cardiac death, major adverse cardiovascular events and definite or probable incidence rate of stent thrombosis.