对比经皮冠状动脉介入治疗和小切口直接冠状动脉旁路移植术治疗前降支基底部狭窄的临床疗效的荟萃分析  

A Systemic Review and Meta-analysis of Clinical Efficacy between Minimally Invasive Direct Coronary Bypass Grafting and Percutaneous Coronary Intervention for Stenosis Treatment of the Proximal Left Anterior Descending Artery

作　　者：张继倬[1] 公兵[2] 杨秀滨[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院心外科,北京100038 [2]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院外科,北京100037

出　　处：《中国医科大学学报》2014年第5期401-406,共6页Journal of China Medical University

基　　金：国家自然科学基金(81200136)

摘　　要：目的经皮冠状动脉介入治疗（PCI）以及小切口冠状动脉旁路移植术（MIDCAB）是目前治疗孤立的冠状动脉前降支基底部狭窄的两种常用方法。为了更好地衡量两种方法的术后疗效,我们利用现有的临床数据进行这一系统评价和Meta分析。方法计算机检索PubMed、EMBASE以及Cochrane,收集公开发表的有关对比PCI和MIDCAB术后疗效的相关文献,提取相关数据,并用Stata12.0软件进行数据分析。结果共纳入7例随机对照临床试验,总计纳入928例,其中PCI组489例,MIDCAB组439例。荟萃分析研究结果发现PCI组与MIDCAB组相比术后的靶血管再血管化率[相对危险度=3.75,95%可信区间：2.3～6.11,P〈0.01]明显高于后者,且差异有统计学意义,而对于全因死亡[相对危险度=0.86,95%可信区间：0.56～1.32,P=0.483]、主要心脑血管不良事件发生率（MACCE）[相对危险度=1.64,95%可信区间：0.57～4.71,P=0.355]两者之间的差异无统计学意义。结论MIDCAB治疗前降支基底部狭窄的临床疗效部分优于PCI。Objective Percutaneous intervention（PCI）and minimally invasive direct coronary bypass grafting（MIDCAB）are the two well accepted treatments for stenosis of the proximal left anterior descending artery. In order to better evaluate the therapeutic efficacy between these two methods,we performed a systemic review and meta-analysis of these studies. Methods PubMed,EMBASE and Cochrane were searched,and related data were retrieved. Stata12.0 was used to perform the meta-analysis. Results Totally 7 studies and 928 patients were recruited in this study,including 489 in PCI group and 439 in MIDCAB group. The results of meta-analysis revealed that patients in PCI group had a higher rate of repeat revascularization[relative risk（RR）=3.75,95%CI：2.3-6.11,P〈 0.01].No significant difference was found in neither all-cause mortality[RR=0.86,95%CI：0.56-1.32,P =0.483]nor main adverse cardiovascular and cerebrovascular events（MACCE）[RR=1.64,95%CI：0.57-4.71,P =0.355]. Conclusion The therapeutic efficacy of MIDCAB were partially better than that of PCI.

关 键 词：前降支基底部狭窄 经皮冠状动脉介入治疗 小切口冠状动脉旁路移植术 疗效 

分 类 号：R654.2[医药卫生—外科学]