PCI简单与复杂策略治疗冠状动脉分叉病变5年随访结果的Meta分析

The 5 years follow-up results of PCI simple strategy compared with complex strategy for coronary bifurcation lesions:a meta-analysis

目的系统评价经皮冠状动脉介入治疗(PCI)简单和复杂策略治疗冠脉分叉病变的远期临床效果。方法计算机检索Pub Med、EMbase、The Cochrane Library和CNKI等数据库,检索时间均为从建库至2017年7月,收集PCI简单和复杂策略治疗冠状动脉分叉病变的随机对照试验(RCT),由2名研究者独立检索和评价相关文献,用Stata12.0软件进行数据统计学处理。结果纳入4个RCT研究,共1455例患者。Meta分析结果显示:两组在全因死亡率(RR=1.50,95%CI:0.98~2.29,P=0.065)、不良心血管事件发生率(RR=0.97,95%CI:0.62~1.51,P=0.889)、心源性死亡率(RR=1.09,95%CI:0.49~2.44,P=0.832)、心肌梗死发生率(RR=1.69,95%CI:0.92~3.09,P=0.090)、靶病变血运重建发生率(RR=0.92,95%CI:0.53~1.61,P=0.774)和支架内血栓发生率(RR=1.00,95%CI:0.47~2.14,P=1.000)差异均无统计学意义。结论与PCI简单策略相比,复杂策略治疗冠状动脉分叉病变并未增加远期不良临床事件发生率;对于急性冠脉综合征患者及冠状动脉真分叉病变而言,PCI复杂策略治疗冠状动脉分叉病变可能是一种合理选择。

Objective To evaluate the long - term clinical effect of percutaneous coronary intervention （PCI） in the treatment of coronary artery bifurcation with simple and complex strategies. Methods The databases of PubMed, Embase, the Cochrane Library and CNKI until July 2017 were retrieved for collecting the randomized controlled trials （RCTs） comparing PCI simple strategy with complex strategy for bifurcation lesions. The Meta-analysis was performed using Stata 12.0 software. Results 4 RCTs with a total of 1455 patients reported clinical outcomes of 5 years follow-up. The result of Meta-analysis showed that there was no significant difference with respect of all cause death （RR=1.50, 95%CI： 0.98~2.29, P=0.065）, major adverse cardiac event （RR=0.97, 95%CI： 0.62~1.51, P=0.889）, cardiac death （RR=1.09, 95%CI： 0.49~2.44, P=0.832）, myocardial infarction （RR=1.69, 95%CI： 0.92~3.09, P=0.090）, target lesion revascularization （RR=0.92, 95%CI： 0.53~1.61, P=0.774） and stent thrombosis （RR=1.00, 95%CI： 0.47~2.14, P=1.000） between two strategies. Conclusion Complex strategy for treating patients with bifurcation lesions didn＇t increase adverse events rate in long-term. Complex strategy may be an optimal method for the patients with ACS or truth bifurcation lesions.