对比微创胸廓内动脉搭桥术和经皮冠状动脉血管重建治疗左前降支孤立性病变的荟萃分析  

Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery

作　　者：Omer Aziz Christopher Rao Sukhmeet Singh Panesar Catherine Jones Stephen Morris Ara Darzi Thanos Athanasiou 杨旭（译） 高润霖（校） 

机构地区：[1]Department of Biosurgery and surgical Technology, Imperial College London, St Mary＇s Hospital, London W2 1NY [2]Tanaka Business School,Lmperial College London [3]不详

出　　处：《英国医学杂志中文版》2007年第6期336-343,共8页The BMJ Chinese Edition

基　　金：Department of Biosurgery and surgery Technology;Imperial College London 在研研究中的一部分

摘　　要：目的比较微创左胸廓内动脉冠状动脉搭桥术和经皮冠状动脉支架术作为初始治疗方法治疗左前降支孤立性病变的结果。设计将已发表文献中的随机和非随机的比较性研究进行荟萃分析。数据来源 Embase,Medline,Cochrane,Google Scholar 以及 Health Technology Assessmentdatabases(1966-2005)。综述方法检索和找出以上数据库中采用这两种方法初始治疗孤立性左前降支狭窄的所有比较性研究,并提取以下内容:研究设计,人口学特征,冠心病的严重程度,心血管疾病的高危因素以及有关的治疗结果。结果本荟萃分析包括了来自8个研究小组的12项研究(1952例患者):其中1项回顾性研究,1项非随机前瞻性研究,6项随机前瞻性研究。随机临床试验的荟萃分析显示经皮冠状动脉支架术组有相对较高的心绞痛复发率(比数比2.62,95%可信区间1.32～5.21),主要冠状动脉和脑血管事件发生率较高(2.86,1.62～5.08),需要再次血运重建率亦较高(4.63,2.52～8.51)。在最大随访终点时,两种治疗方法在心肌梗死、脑卒中或死亡率上无显著性差异。结论与经皮冠状动脉支架术相比,微创左胸廓内动脉搭桥术治疗左前降支孤立性病变的中期并发症发生率较低。Objectives To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery. Design Meta-analysis of randomised and nonrandomised comparative peer reviewed publications. Data sources Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases （ 1966-2005 ）. Review methods Studies comparing the two procedures as the primary intervention for isolated left anterior descending artery stenosis were identified and the following extracted： study design, population characteristics, severity of coronary artery disease, cardiovascular risk factors, and outcomes of interest. Results 12 studies （1952 patients） reporting results from eight groups were included： one was a retrospective design, one prospective nonrandomised, and six prospective randomised. Metaanalysis of randomised trials showed a higher rate of recurrence of angina （odds ratio 2.62, 95% confidence interval 1.32 to 5.21 ）, incidence of major adverse coronary and cerebral events （2. 86, 1.62 to 5.08 ） , and need for repeat revascularisation （4. 63, 2. 52 to 8.51） with percutaneous stenting. No significant difference was found in myocardial infarction, stroke, or mortality at maximum followup between interventions.

关 键 词：胸廓内动脉搭桥术 左前降支狭窄 孤立性病变 冠状动脉血管 荟萃分析 重建治疗 经皮冠状动脉支架术 微创 

分 类 号：R654.2[医药卫生—外科学]