Table_3_Cardiac Shock Wave Therapy in Coronary Artery Disease: A Systematic Review and Meta-Analysis.DOCX

ObjectiveCoronary artery disease (CAD) has been one of the leading causes of morbidity and mortality worldwide. Cardiac shock wave therapy (CSWT) is a novel and non-invasive therapy for CAD. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CSWT on CAD.
Methods and resultsWe performed a comprehensive search of electronic databases such as PubMed, Embase, the Cochrane Library, and Wanfang Data in October 2021. The results were reported as weighted mean difference (WMD) with a 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran’s Q test and the I2 statistic. A total of 8 randomized trials and 2 prospective cohort studies, together involving 643 patients (n = 336 CSWT and n = 307 control), were included in our study. Eight studies with 371 patients showed significantly improved rest left ventricular ejection fraction (LVEF) with CSWT as compared to that of the control group (WMD 3.88, 95% CI 1.53–6.23, p = 0.001, I2 = 51.2%). Seven studies with 312 patients reported left ventricular internal diameter in diastole (LVIDd) were markedly decreased in the CSWT group compared to the control group (WMD −1.81, 95% CI −3.23 to −0.39, p = 0.012, I2 = 20.3%). The summed stress score significantly favored the CSWT group (WMD −3.76, 95% CI −6.15 to −1.37, p = 0.002, I2 = 56.8%), but there was no significant difference for the summed rest score. Our data were acquired from studies without a perceived high risk of bias, so plausible bias is unlikely to seriously affect the main findings of the current study.
ConclusionBased on data from our present meta-analysis, CSWT was shown to moderately improve myocardial perfusion and cardiac function among patients with CAD, which would provide the clinicians with a meaningful and valuable option.
Systematic Review RegistrationThe meta-analysis was registered on the Open Science Framework (OSF) (https://osf.io/r2xf9).

研究目的：冠状动脉疾病（Coronary artery disease, CAD）是全球范围内导致发病与死亡的主要病因之一。心脏冲击波疗法（Cardiac shock wave therapy, CSWT）是一种针对CAD的新型无创治疗手段。为此，本研究开展系统评价与Meta分析，以评估CSWT治疗CAD的临床疗效。

方法与结果：本研究于2021年10月对PubMed、Embase、Cochrane图书馆及万方数据等电子数据库进行了全面检索。研究结果以加权均数差（weighted mean difference, WMD）结合95%置信区间（confidence interval, CI）进行报告。采用标准Cochran Q检验及I²统计量评估研究间的统计学异质性。最终纳入8项随机对照试验与2项前瞻性队列研究，共计643例患者（CSWT组336例，对照组307例）。其中8项涉及371例患者的研究显示，相较于对照组，CSWT可显著改善患者静息左心室射血分数（left ventricular ejection fraction, LVEF）（WMD=3.88，95%CI：1.53~6.23，p=0.001，I²=51.2%）。7项涉及312例患者的研究表明，与对照组相比，CSWT组患者的舒张末期左室内径（left ventricular internal diameter in diastole, LVIDd）显著降低（WMD=-1.81，95%CI：-3.23~-0.39，p=0.012，I²=20.3%）。负荷总积分同样显著偏向CSWT组（WMD=-3.76，95%CI：-6.15~-1.37，p=0.002，I²=56.8%），但静息总积分组间差异无统计学意义。本研究纳入的研究均无较高偏倚风险，因此潜在偏倚不太会对本研究的主要结果造成严重影响。

结论：基于本次Meta分析的数据结果，CSWT可适度改善CAD患者的心肌灌注与心功能，可为临床医师提供一项具有临床意义的可选治疗方案。

系统评价注册信息：本项Meta分析已在开放科学框架（Open Science Framework, OSF）平台注册（https://osf.io/r2xf9）。