可吸收药物洗脱冠状动脉支架系统治疗冠心病的快速卫生技术评估Meta分析

Rapid health technology assessment Meta-analysis of drug-eluting coronary stent system for the treatment of coronary heart disease

目的:采用快速卫生技术评估工具,评价可吸收药物洗脱冠状动脉支架系统的安全性、有效性和经济性,以期为临床医生合理使用及专家评估提供循证依据。方法:检索2014年1月1日至2023年1月1日美国国家医学图书网PubMed、中国知网、万方及维普等数据库中关于患有冠心病且治疗手段为冠状动脉支架介入式手术的相关文献,对获取的210篇文献按照纳入与排除标准筛选提取文献资料并进行文献质量评价,将提取的可吸收药物洗脱冠状动脉支架与药物洗脱冠状动脉支架血管内血栓形成率、心肌梗死率、心源性病死率、全因性病死率、靶病变血运重建率及血管内不良事件发生率相关数据资料,采用Revman 5.4软件进行Meta分析。结果:最终纳入7篇文献进行可吸收药物洗脱冠状动脉支架与药物洗脱冠状动脉支架的比较研究。采用可吸收药物洗脱冠状动脉支架的血栓形成率、全因性病死率和血管内不良事件发生率小于药物洗脱冠状动脉支架,差异有统计学意义(Z=2.16、1.89、2.22,P<0.05);采用可吸收药物洗脱冠状动脉支架的心肌梗死率、心源性病死率和靶病变血运重建率与采用药物洗脱冠状动脉支架比较,差异无统计学意义(P>0.05)。结论:可吸收药物洗脱冠状动脉支架与药物洗脱冠状动脉支架在安全性和有效性无明显差异,经济性考虑可吸收药物洗脱冠状动脉支架的费用明显高于药物洗脱冠状动脉支架,患者可依据自身经济条件等实际情况作出支架的选用。

Objective:To evaluate the effectiveness,safety and economics of absorbable drug-eluting coronary stent systems using rapid health technology assessment tools,and to provide evidence-based basis for rational use for clinicians use and expert evaluation.Methods:A computer search was performed on PubMed,CNKI,Wanfang,VIP and other databases from 1 January 2014 to 1 January 2023 for relevant literature on patients with coronary artery disease who were treated with coronary artery stent interventional surgery.The 210 collected literatures were screened and extracted according to the inclusion and exclusion criteria,and the literature quality evaluation was carried out.The extracted data related to the intravascular thrombosis rate,myocardial infarction rate,cardiac mortality rate,all-cause mortality rate,target lesion revascularization rate and intravascular adverse event incidence of absorbable drug-eluting coronary stents and drug-eluting coronary stents were meta-analyzed by Revman5.4 software.Results:7 studies were ultimately included in the comparative study of absorbable drug-eluting coronary stents and drug-eluting coronary stents.The thrombosis rate,all-cause mortality rate and intravascular adverse event rate of absorbable drug-eluting coronary stents were lower than those of drug-eluting coronary stents,and the difference was statistically significant(Z=2.16,1.89,2.22,P<0.05).There were no statistically significant difference in the myocardial infarction rate,cardiac mortality rate and target lesion revascularization rate between absorbable drug-eluting coronary stents and drug-eluting coronary stents(P>0.05).Conclusion:There was no significant difference in safety and efficacy between absorbable drug-eluting coronary stents and drug-eluting coronary stents.In terms of economy,the cost of absorbable drug-eluting coronary stents is significantly higher than that of drug-eluting coronary stents,and patients can choose stents according to their own economic conditions and other actual conditions.