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ESC 2013:贝叶斯荟萃分析显示与更佳药物治疗相比,PCI治疗并不能使稳定性缺血性心脏病患者获益

2013-09-03 MedSci MedSci原创

  背景:众所周知,经皮冠状动脉介入治疗(PCI)治疗急性冠状动脉综合征具有公认的优势,但其在稳定性缺血性心脏病(SIHD)中的作用尚不明确。   目的:该研究旨在评估PCI与最佳药物治疗(OMT)对比试验中死亡或心肌梗死(MI)及全因死亡率的复合风险比。   方法:检索OVID/Medline中从1946年至今所有已发表的OMT与PCI的相关对比文献。由两名 临床研究者对其进行独立审查,并

  背景:众所周知,经皮冠状动脉介入治疗(PCI)治疗急性冠状动脉综合征具有公认的优势,但其在稳定性缺血性心脏病(SIHD)中的作用尚不明确。

  目的:该研究旨在评估PCI与最佳药物治疗(OMT)对比试验中死亡或心肌梗死(MI)及全因死亡率的复合风险比。

  方法:检索OVID/Medline中从1946年至今所有已发表的OMT与PCI的相关对比文献。由两名 临床研究者对其进行独立审查,并将其数据摘录到通用数据库中。然后由第三个研究者对数据进行审议,采用DerSimonian及Laird 随机效应模型行荟萃分析,并进行贝叶斯分析。

  结果:共计入选16项主要的随机临床试验。荟萃分析结果显示,所有试验中PCI与OMT的MI/死亡复合终点无差异(RR 0.975,95%CI:0.754~1.261,W=100%,I2=89.9%);对稳定性心绞痛及心肌梗死后试验的单独分析也未见两者之间有差异(RR 1.024,95%CI:0.905~1.160,W=100%,I2=23.5%)。此外,与OMT相比,PCI并不能降低全因死亡率的相对风险(汇集RR 0.986,95%CI:0.841~1.156,W=100%,I2=0%)。贝叶斯分析的结果与之相似。

  结论:该研究证实,与OMT相比,PCI并不能为SIHD患者带来MI/死亡复合终点或全因死亡率方面的额外获益。

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