单支架与双支架技术治疗无保护左主干临床疗效的Meta分析

Clinical outcomes of single stenting compared with double stenting technology for unprotected left main coronary artery disease:a Meta-analysis

目的:对无保护左主干(ULMCA)疾病的最佳介入策略是富有争议的,并缺乏单支架技术与双支架技术治疗ULMCA的临床效果比较。本研究通过Meta分析评估两种干预技术的临床效果。方法:计算机检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网和万方数据库,检索有关单支架技术对比双支架技术治疗ULMCA疾病的临床试验,检索时限均为从建库至2019年1月。由2名评价员独立筛选文献、提取资料和评价纳入研究的质量,采用Stata 15.0软件进行Meta分析。结果:最终纳入15项回顾性队列研究,共计5 721例患者,其中单支架治疗患者3 308例,双支架治疗患者2 413例。与双支架相比较,单支架技术与较低的主要不良心血管事件(MACE)(OR=0.71,95%CI:0.54~0.94)及较低的靶病灶血运重建(TLR)(OR=0.55,95%CI:0.47~0.64)风险相关。单支架与双支架技术在全因死亡率、心血管死亡率、心肌梗死(MI)和支架栓塞(ST)方面差异无统计学意义。结论:在治疗ULMCA方面,与双支架相比,单支架技术可降低发生MACE和TLR的风险,具有更好的临床治疗效果。

Objective:The optimal interventional strategy for unprotected left main coronary artery(ULMCA)disease is debatable.Clinical outcomes of single stenting compared with double stenting technology for ULMCA are lacking.We perform a Meta-analysis to evaluate the clinical effects of the two intervention technologies.Method:PubMed,EMbase,The Cochrane Library,CBM,CNKI and Wanfang Data were searched for clinical trials of single stenting versus double stenting technology in the treatment of ULMCA disease published from the establishment of the database to January 2019.Two reviewers independently screened articles,extracted data,and evaluated their quality.Stata 15.0 was used for Meta-analysis.Result:The selected 15 retrospective cohort studies contained 5 721 patients,including 3 308 in single stenting group and 2 413 in double stenting group.Single stenting was associated with lower risk of major adverse cardiovascular events(MACE)(OR=0.71,95%CI:0.54-0.94)and target lesion revascularization(TLR)(OR=0.55,95%CI:0.47-0.64)compared with double stenting.No difference was observed in all-cause mortality,cardiac mortality,myocardial infarction(MI)and stent thrombosis(ST)between single stenting and double stenting.Conclusion:In the intervention of ULMCA,single stenting technology can reduce the risk of MACE and TLR with better clinical treatment effect compared with double stenting technology.