经皮冠状动脉介入术后≤6个月与≥12个月双联抗血小板治疗的Meta分析

Meta-analysis of dual antiplatelet therapy for 6 months and 12 months after percutaneous coronary intervention

目的系统评价经皮冠状动脉介入术后≤6个月双联抗血小板治疗(DAPT)与≥12个月DAPT的疗效与安全性。方法计算机检索Pub Med、The Cochrane Library、EMbase、Web of Science、CBM、Wan Fang Data、VIP、CNKI数据库,搜集有关经皮冠状动脉介入术后双联抗血小板治疗时限的随机对照试验,检索时间均从建库至2016年11月。检索采用Me SH主题词和自由词相结合的方式检索。筛选文献、提取资料、评价纳入研究偏倚风险后运用Rev Man 5.3软件进行Meta分析。结果最终纳入11个RCT,共21 077例患者,其中≤6个月DAPT治疗组10 492例,≥12个月DAPT治疗组10 585例。Meta分析结果显示:PCI术后≤6个月DAPT治疗与≥12个月DAPT治疗相比主要出血风险明显降低,差异有统计学意义(RR=0.68,95%CI:0.51~0.91,P=0.008);总死亡率、心源性死亡、支架内血栓形成、心肌梗死、卒中、TVR和轻微出血风险均未见明显增加,差异无统计学意义。结论≤6个月DAPT治疗在降低PCI术后患者主要出血风险的同时并未增加患者总死亡率和心源性死亡率,也未增加患者PCI术后支架内血栓形成、心肌梗死、卒中、TVR和轻微出血的发生风险。结论有待于更多高质量RCT加以验证。

Objective To systematically review the efficacy and safety of dual antiplatelet therapy for≤6months and≥12months after percutaneous coronary intervention.Methods Database including PubMed,TheCochrane Library,EMbase,Web of Science,CBM,WanFang Data,VIP,and CNKI are searched electronicallyfrom inception to Nov.2016to collect RCTs of dual antiplatelet therapy after percutaneous coronary intervention.Meta-analysis is performed by RevMan5.3software.Results A total of11RCTs including21077patients wereincluded.The≤6months group has10492patients and the≥12months group has10585patients.The resultof meta-analysis showed that,the≤6months group significantly reduced the major bleeding(RR=0.68,95%CI:0.51~0.91,P=0.008),but there is no significant difference between the two groups in total mortality,cardiacdeath,stent thrombosis,stroke,myocardial infarction,target vessel revascularization(TVR)and minor bleeding.Conclusion Dual antiplatelet therapy for≤6months after percutaneous coronary intervention can reduce the majorbleeding,but will not increase the total mortality,cardiac death,stent thrombosis,stroke,myocardial infarction,TVR and minor bleeding.