侧支病变长度对冠状动脉分叉疾病患者冠状动脉支架置入术后临床结果的影响:一项荟萃分析

Junyan Kan, S. Luo, Dongchen Wang, Dandan Cai, Xiaojuan Zhang, J. Kan
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引用次数: 2

摘要

目的:经皮冠状动脉介入治疗(PCI)分叉病变的最佳技术仍然存在争议,特别是考虑到侧支(SB)的可变性。目前在大多数情况下推荐使用临时支架置入技术。本荟萃分析旨在比较不同分岔PCI策略的结果,阐明其适用范围。方法:系统地从PubMed、Cochrane、Web of Science和EBSCO文献数据库中检索比较PCI治疗冠状动脉分叉病变策略的随机对照试验,不受发表日期和语言的限制。主要不良心血管事件(mace)作为主要结局。次要结局是全因死亡率、心血管死亡率、靶病变血运重建术(TLR)、靶血管血运重建术、心肌梗死(MI)和支架血栓形成。进行合并分析和亚组分析。结果:纳入23项随机对照试验,6380名受试者。18项研究比较了临时策略和双支架方法。mace的相对危险度(RR)为1.16;95%置信区间(CI), 0.90-1.48;I2 = 62%)。然而,当以SB病变长度作为分离条件时,2支架策略与较少的mace相关(RR, 1.87;95% ci, 1.46-2.41;I2 = 70%), TLRs (RR, 2.13;95% ci, 1.50-3.02;I2 = 59%), MIs (RR, 2.17;95% ci, 1.19-3.95;I2 = 52%)比临时策略在那些SB病变测量bbb10毫米长。结论:在目前的工作中,单支架和双支架技术在mace或次要结局方面没有显著差异。然而,由于TLR和MI病例较少,当SB病变长度为bbb10 mm时,2支架入路比临时策略在分叉方面具有临床优势。
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Impact of Side Branch Lesion Length on Clinical Outcome after Coronary Stenting Techniques in Patients with Coronary Artery Bifurcation Disease: A Meta-Analysis
Objective: The optimal percutaneous coronary intervention (PCI) technique for bifurcation lesions remains controversial, especially considering the variability of the side branch (SB). A provisional stenting technique is currently recommended in most cases. This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies, clarifying their scope of application. Methods: Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed, Cochrane, Web of Science, and EBSCO literature databases without limitations on published date or language. Major adverse cardiovascular events (MACEs) were stipulated as main outcomes. Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, target lesion revascularization (TLR), target vessel revascularization, myocardial infarction (MI), and stent thrombosis. Both pooled analysis and sub-group analysis were performed. Results: Twenty-three randomized controlled trials with 6380 participants were included. Eighteen studies compared the provisional strategy with 2-stent approaches. No significant difference in MACEs (relative risk (RR), 1.16; 95% confidence interval (CI), 0.90–1.48; I2 = 62%) was found between 1-stent and 2-stent techniques. However, when SB lesion length was used as the separation condition, the 2-stent strategy was associated with fewer MACEs (RR, 1.87; 95% CI, 1.46–2.41; I2 = 70%), TLRs (RR, 2.13; 95% CI, 1.50–3.02; I2 = 59%), and MIs (RR, 2.17; 95% CI, 1.19–3.95; I2 = 52%) than the provisional strategy in those where SB lesions measured >10 mm long. Conclusions: In the current work, there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes. However, 2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is >10 mm due to fewer cases of TLR and MI.
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