Objective To assess the effectiveness and safety of different dual antiplatelet therapies in patients undergoing percutaneous coronary intervention. Methods Such databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched to collect the randomized controlled trials (RCTs) and observational studies on the effectiveness and safety of dual antiplatelet therapies both short-duration (≤6 months) and long-duration (gt;6 months) after percutaneous coronary intervention. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, the quality was evaluated, the data were extracted, and meta-analyses were performed by using RevMan 5.1 software. Results Eight trials were included, of which 3 were RCTs involving 7 475 patients, and 5 were observational studies involving 12 744 patients. Meta-analyses on RCTs showed that the incidence of death or myocardial infarction in the long-duration treatment group was lower than that of the short-duration treatment group (OR=0.74, 95%CI 0.56 to 0.98, Plt;0.000 1), while meta-analyses on observation studies showed the similar result (OR=0.7, 95%CI 0.45 to 1.08, P=0.11). With the variables of published year and follow-up time, the heterogeneity of cohort studies was discussed through meta-regression (Z=3.61, P=0.000) which indicated that both published year and follow-up time might be the source of heterogeneity due to their contribution. For RCTs, the incidence of severe bleeding events in the short-duration treatment group was lower than that in the long-duration treatment group (OR=1.29, 95%CI 0.99 to 1.69, P=0.06). For observational studies, the incidence of late stent thrombosis in the long-duration treatment group was lower than that in the short-duration treatment group (OR=0.40, 95%CI 0.15 to 1.07, P=0.07). Conclusion The long duration (gt;6months) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction and decrease the tendency of late stent thrombosis, but cannot obviously increase the incidence rate of severe bleeding events. The current evidence shows no marked superiority in longer duration (gt;12months) of dual antiplatelet therapy.
Objective To summarize the experience of emergency coronary artery bypass grafting （CABG） after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection （5 cases）or perforation （2 cases） and acute arterial occlusion （2 cases）. The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.
ObjectiveTo systematically review the efficacy and safety of primary percutaneous coronary intervention (PCI) via radial access versus via femoral access for patients with acute ST-segment elevation myocardial infarction (STEMI). MethodsRandomized controlled trials (RCTs) about the clinical efficacy and safety of radial access for PCI in patients with acute STEMI were searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 6, 2014), CNKI, VIP, and WanFang Data from 2000 to November 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of included studies were completed by two reviewers independently. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of fourteen RCTs involving 5 212 patients were enrolled. The results indicated that:a) radial access was associated with decreased risks of mortality (OR=0.54, 95%CI 0.40 to 0.74, P=0.000 1); decreased incidences of major bleeding (OR=0.50, 95%CI 0.34 to 0.74, P=0.000 8), major adverse cardiac events (MACE) (OR=0.65, 95%CI 0.50 to 0.83, P=0.000 6), and puncture site complications (OR=0.35, 95%CI 0.25 to 0.49, P < 0.000 01); and decreased hospital duration (MD=-2.14, 95%CI-3.97 to-0.31, P=0.002). b) However, the two groups were alike in the success rate of operation, exposure time of X ray, risk of stroke, and the rate of CABG. PCI via radial access took more operation time than that via femoral access, and PCI via radial access had a higher incidence of changing puncture access. ConclusionFor acute STEMI patients undergoing PCI, radial access could significantly reduce mortality, and incidences of major bleeding, MACE and puncture site complications. Therefore, under the conditions of strict indication control and increased operation skills, PCI via radial access is effective and safe in the treatment of acute STEMI. Due to limited quality and quantity of the included studies, more large-scale, multi-centre, high quality RCTs are needed to verify the above conclusion.
Objective To evaluate the clinical efficacy and safety of triple-antiplatelet treatment based on Cilostazol for restenosis after percutaneous coronary intervention. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2009), PubMed (1966 to 2009), EMbase (1974 to 2009), CNKI (1994 to 2009), CBM (1978 to Feb. 2009), VIP (1989 to Feb. 2009), and CMD Digital Periodicals (1998 to 2009). Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed using RevMan 5.0 software. Results Five randomized controlled trials (RCTs) involving 2 348 patients were included. The results of meta-analyses showed that triple-antiplatelet treatment based on Cilostazol could increase minimum lumen diameter (MD=0.31, 95%CI 0.11 to 0.51) and decrease restenosis rate (OR=0.49, 95%CI 0.37 to 0.65). In addition, it could decrease death rate (OR=0.52, 95%CI 0.31 to 0.88), but it could not change target-vessel revascularization, stroke rate, palpitation rate, and the rate of major adverse cardiac and cerebral events and major adverse cardiac events. Conclusion Evidence shows that triple-antiplatelet treatment based on Cilostazol could increase minimum lumen diameter and decrease restenosis rate and death rate. Their clinical application is worthy to be advocated.
ObjectiveTo systematically review the effect of compound Danshen dripping pills combined with Western medicine on inflammatory factors and cardiac function after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction.MethodsDatabases including CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, EMbase and The Cochrane Library were searched for randomized controlled trials of compound Danshen dripping pills combined with Western medicine in the treatment of acute myocardial infarction after PCI. The retrieval time was from the establishment of the databases to June 11th, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk bias of included studies. RevMan 5.3 software was used for meta-analysis.ResultsA total of 16 studies were included, involving 2 069 patients. The results of the meta-analysis showed that the combination of compound Danshen dripping pills could increase the left ventricular ejection fraction (MD =−4.74, 95%CI 4.07 to 5.42, P<0.01), decrease the B-type natriuretic peptide (SMD=−3.81, 95%CI −5.06 to −2.57, P<0.01), the level of interleukin-6 (SMD=−3.20, 95%CI −4.54 to −1.86, P<0.01) and level of tumor necrosis factor-a (SMD=−4.96, 95%CI −7.03 to −2.89, P<0.01).ConclusionsCurrent evidence suggests that the combination of compound Danshen dropping pills has potential benefits in inhibiting inflammation and improving cardiac function after PCI. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
Objectives To systematically review the efficacy and safety of clopidogrel 600 mg and 300 mg loading dose in Chinese patients underwent percutaneous coronary intervention (PCI). Methods We searched The Cochrane Library, EMbase, PubMed, CNKI, WanFang Data, CBM and VIP databases to collect randomized controlled trials (RCTs) of the efficacy and safety of clopidogrel 600 mg and 300 mg loading dose in Chinese patients underwent PCI from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.0 software. Results A total of 10 RCTs involving 1 166 patients were included. The results of meta-analysis showed that: the 600 mg loading dose group had lower incidence rate of major adverse cardiovascular events (MACE) in comparison with the 300 mg loading dose group (RR=0.29, 95%CI 0.17 to 0.48, P<0.000 1). However, no significant difference was found in the incidence of major bleeding events within 30 days between two groups (RR=1.64, 95%CI 0.70 to 3.80,P=0.252). Conclusions The current evidence shows that in Chinese patients underwent PCI, administration of a 600 mg loading dose of clopidogrel is associated with a lower risk of MACE than is administration of a 300 mg loading dose of clopidogrel, without increasing major bleeding risk in 30 days. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To systematically review the efficacy and safety of minimally invasive direct coronary artery bypass (MIDCAB) grafting versus percutaneous coronary intervention (PCI) for patients with single-vessel disease of the left anterior descending artery (LAD). Methods Databases including The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to Oct. 2015, to collect randomized controlled trials (RCTs) about MIDCAB versus PCI for single-vessel disease of the LAD. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs including 1 489 patients were included. The results of meta-analysis showed that: compared with the PCI group, the MIDCAB group could significantly reduce the incidence of postoperative target vessel revascularization (OR=0.20，95%CI 0.13 to 2.29，P < 0.000 01), and the incidence of main adverse cardiovascular and cerebrovascular events (MACCE) (OR=0.44, 95%CI 0.33 to 0.58, P < 0.000 01). No significant differences were found between the two groups in total case mortality (OR=1.23, 95%CI 0.83 to 1.83, P=0.31), cardiogenic death (OR=1.12, 95%CI 0.59 to 2.12, P=0.73), and the incidence of postoperative myocardial infarction (OR=2.16, 95%CI 0.83 to 5.59, P=0.11). Conclusion In reducing the incidences of postoperative target vessels again revascularization and MACCE of patients with single-vessel disease of the LAD, MIDCAB is superior to PCI. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
Objective To evaluate the effectiveness and security through meta-analysis of a comprehensive study of efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent percutaneous coronary intervention (DES-PCI), for diabetes mellitus with multi-vessel coronary disease. Methods Databases including The Cochrane Library, PubMed, MEDLINE, EMbase, CBM, CNKI, WanFang Data and VIP were searched from their establishment dates to 2010. Published information and conference papers including references were handsearched. Relevant randomized controlled trials (RCTs) on diabetic patients with coronary multi-vessel disease treated with revascularization were collected and screened by two reviewers independently. After data extraction and quality assessment of the included studies, meta-analysis was performed using RevMan 5.0. Results A total of eight studies involving a total of 3 689 cases (CABG group: 1 814 cases; DES-PCI group: 1 875 cases) were included. Results of meta-analyses showed that: compared with the DES-PCI group, the CABG group could significantly reduce postoperative repeat revascularization rate (OR=0.27, 95% CI 0.10 to 0.69, P=0.006) and major cardio-cerebral vascular events (OR=0.49, 95% CI 0.38 to 0.62, Plt;0.000 01). But in reducing mortality rate (OR=0.84, 95%CI 0.64 to 1.10, P=0.21), cerebrovascular events (OR=2.00, 95%CI 0.97 to 4.14, P=0.06) and myocardial infarction incidence rate (OR=0.92, 95%CI 0.53 to 1.59, P=0.75), there were no significant differences between the two groups. Conclusion CABG is superior to DES-PCI in the treatment of diabetic patients with multi-vessel disease. However, due to the limitation of the quality and quantity of the included studies, the above conclusion should be tested by conducting more large-scale, multi-center and prospective RCTs in future.
ObjectiveTo systematically review the efficacy and safety of triple antiplatelet therapy (TAT:aspirin, clopidogrel and cilostazol) for patients with coronary heart diseases after percutaneous coronary intervention. MethodsSuch databases as The Cochrane Library (Issue 2, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant randomized controlled trials (RCTs) on the efficacy and safety of TAT for patients with coronary heart diseases after percutaneous coronary intervention from inception to February 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 15 RCTs involved 6 980 patients were included. The results of meta-analysis showed that:a) the DAT group (DAT:aspirin and clopidogrel) and the TAT group were similar in non-fatal myocardial infarction (OR=0.72, 95%CI 0.47 to 1.10, P=0.05), stroke (OR=0.66, 95%CI 0.38 to 1.16, P=0.15), and hemorrhage (OR=1.03, 95%CI 0.74 to 1.44, P=0.85) with no significant difference; b) the TAT group was superior to the DAT group in reducing the incidences of the major cardiovascular and cerebrovascular events (MACCE) (OR=0.50, 95%CI 0.39 to 0.65, P < 0.000 01), cardiac death (OR=0.53, 95%CI 0.33 to 0.84, P=0.007), stent thrombosis (OR=0.52, 95% CI 0.27 to 0.99, P=0.05), target vessel revascularization (OR=0.63, 95%CI 0.51 to 0.76, P < 0.000 01), and target lesion revascularization (OR=0.44, 95%CI 0.28 to 0.70, P=0.000 6); and c) no significant difference was found between the two groups in the incidences of thrombocytopenia, leucopenia, and liver damage. The DAT group was superior to the TAT group in gastrointestinal reaction, palpitations, headache, and skin rashes between the two groups, with significant differences. ConclusionTAT therapy has good efficacy and safety in the treatment of patients with coronary heart diseases after percutaneous coronary intervention.