{"title":"药物洗脱支架支架内再狭窄的危险因素和发生率：系统回顾和荟萃分析。","authors":"Birong Liu, Meng Li, Jia Liu, Lihua Xie, Jiaqi Li, Yong Liu, Chaofeng Niu, Di Xiao, Jingen Li, Lijing Zhang","doi":"10.31083/j.rcm2512458","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite significant reductions in in-stent restenosis (ISR) incidence with the adoption of drug-eluting stents (DES) over bare metal stents (BMS), ISR remains an unresolved issue in the DES era. The risk factors associated with DES-ISR have not been thoroughly analyzed. This meta-analysis aims to identify the key factors and quantify their impact on DES-ISR.</p><p><strong>Methods: </strong>We conducted comprehensive literature searches in PubMed, EMBASE, Cochrane, and Web of Science up to 28 February 2023, to identify studies reporting risk factors for DES-ISR. Meta-analysis was performed on risk factors reported in two or more studies to determine their overall effect sizes.</p><p><strong>Results: </strong>From 4357 articles screened, 17 studies were included in our analysis, evaluating twenty-four risk factors for DES-ISR through meta-analysis. The pooled incidence of DES-ISR was approximately 13%, and significant associations were found with seven risk factors. Ranked risk factors included diabetes mellitus (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.14-1.87), stent length (OR: 1.026; 95% CI: 1.003-1.050), number of stents (OR: 1.62; 95% CI: 1.11-2.37), involvement of the left anterior descending artery (OR: 1.56; 95% CI: 1.25-1.94), lesion length (OR: 1.016; 95% CI: 1.008-1.024), medical history of myocardial infarction (OR: 1.79; 95% CI: 1.12-2.86) and previous percutaneous coronary intervention (OR: 1.97; 95% CI: 1.53-2.55). Conversely, a higher left ventricular ejection fraction was identified as a protective factor (OR: 0.985; 95% CI: 0.972-0.997).</p><p><strong>Conclusions: </strong>Despite advancements in stent technology, the incidence of ISR remains a significant clinical challenge. Our findings indicate that patient characteristics, lesion specifics, stent types, and procedural factors all contribute to DES-ISR development. Proactive strategies for early identification and management of these risk factors are essential to minimize the risk of ISR following DES interventions.</p><p><strong>The prospero registration: </strong>CRD42023427398, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=427398.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 12","pages":"458"},"PeriodicalIF":1.9000,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683691/pdf/","citationCount":"0","resultStr":"{\"title\":\"Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis.\",\"authors\":\"Birong Liu, Meng Li, Jia Liu, Lihua Xie, Jiaqi Li, Yong Liu, Chaofeng Niu, Di Xiao, Jingen Li, Lijing Zhang\",\"doi\":\"10.31083/j.rcm2512458\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite significant reductions in in-stent restenosis (ISR) incidence with the adoption of drug-eluting stents (DES) over bare metal stents (BMS), ISR remains an unresolved issue in the DES era. The risk factors associated with DES-ISR have not been thoroughly analyzed. This meta-analysis aims to identify the key factors and quantify their impact on DES-ISR.</p><p><strong>Methods: </strong>We conducted comprehensive literature searches in PubMed, EMBASE, Cochrane, and Web of Science up to 28 February 2023, to identify studies reporting risk factors for DES-ISR. Meta-analysis was performed on risk factors reported in two or more studies to determine their overall effect sizes.</p><p><strong>Results: </strong>From 4357 articles screened, 17 studies were included in our analysis, evaluating twenty-four risk factors for DES-ISR through meta-analysis. The pooled incidence of DES-ISR was approximately 13%, and significant associations were found with seven risk factors. Ranked risk factors included diabetes mellitus (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.14-1.87), stent length (OR: 1.026; 95% CI: 1.003-1.050), number of stents (OR: 1.62; 95% CI: 1.11-2.37), involvement of the left anterior descending artery (OR: 1.56; 95% CI: 1.25-1.94), lesion length (OR: 1.016; 95% CI: 1.008-1.024), medical history of myocardial infarction (OR: 1.79; 95% CI: 1.12-2.86) and previous percutaneous coronary intervention (OR: 1.97; 95% CI: 1.53-2.55). Conversely, a higher left ventricular ejection fraction was identified as a protective factor (OR: 0.985; 95% CI: 0.972-0.997).</p><p><strong>Conclusions: </strong>Despite advancements in stent technology, the incidence of ISR remains a significant clinical challenge. Our findings indicate that patient characteristics, lesion specifics, stent types, and procedural factors all contribute to DES-ISR development. Proactive strategies for early identification and management of these risk factors are essential to minimize the risk of ISR following DES interventions.</p><p><strong>The prospero registration: </strong>CRD42023427398, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=427398.</p>\",\"PeriodicalId\":20989,\"journal\":{\"name\":\"Reviews in cardiovascular medicine\",\"volume\":\"25 12\",\"pages\":\"458\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-12-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683691/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reviews in cardiovascular medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.31083/j.rcm2512458\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/j.rcm2512458","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis.
Background: Despite significant reductions in in-stent restenosis (ISR) incidence with the adoption of drug-eluting stents (DES) over bare metal stents (BMS), ISR remains an unresolved issue in the DES era. The risk factors associated with DES-ISR have not been thoroughly analyzed. This meta-analysis aims to identify the key factors and quantify their impact on DES-ISR.
Methods: We conducted comprehensive literature searches in PubMed, EMBASE, Cochrane, and Web of Science up to 28 February 2023, to identify studies reporting risk factors for DES-ISR. Meta-analysis was performed on risk factors reported in two or more studies to determine their overall effect sizes.
Results: From 4357 articles screened, 17 studies were included in our analysis, evaluating twenty-four risk factors for DES-ISR through meta-analysis. The pooled incidence of DES-ISR was approximately 13%, and significant associations were found with seven risk factors. Ranked risk factors included diabetes mellitus (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.14-1.87), stent length (OR: 1.026; 95% CI: 1.003-1.050), number of stents (OR: 1.62; 95% CI: 1.11-2.37), involvement of the left anterior descending artery (OR: 1.56; 95% CI: 1.25-1.94), lesion length (OR: 1.016; 95% CI: 1.008-1.024), medical history of myocardial infarction (OR: 1.79; 95% CI: 1.12-2.86) and previous percutaneous coronary intervention (OR: 1.97; 95% CI: 1.53-2.55). Conversely, a higher left ventricular ejection fraction was identified as a protective factor (OR: 0.985; 95% CI: 0.972-0.997).
Conclusions: Despite advancements in stent technology, the incidence of ISR remains a significant clinical challenge. Our findings indicate that patient characteristics, lesion specifics, stent types, and procedural factors all contribute to DES-ISR development. Proactive strategies for early identification and management of these risk factors are essential to minimize the risk of ISR following DES interventions.
The prospero registration: CRD42023427398, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=427398.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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