冠状动脉旁路移植术与经皮冠状动脉介入治疗对冠心病患者远期预后影响的荟萃分析  

Meta-analysis of long-term outcomes of percutaneous coronary intervention or coronary artery bypass graft surgery in coronary artery disease patients with multi-vessel and/or left main stem disease

作　　者：孙同文[1] 万有栋[1] 刘子琪[1] 张曙光[1] 关方霞[2] 姚瑞[3] 张力[3] 李凌[3] 张金盈[3] 阚全程[4] 

机构地区：[1]郑州大学第一附属医院综合重症监护室,450052 [2]河南省医学科学院郑州大学生命科学学院 [3]郑州大学第一附属医院心内科,450052 [4]郑州大学第一附属医院药学部,450052

出　　处：《中华心血管病杂志》2014年第8期693-698,共6页Chinese Journal of Cardiology

基　　金：河南省医学科技攻关计划省部共建项目（201301005）;河南省医学科技攻关计划（20120307）;河南省高校科技创新人才专项基金（2012HASTIT001）;河南省卫生科技创新人才工程专项基金（豫卫科2010-52）;河南省科技成果转化项目（122102310584）

摘　　要：目的 采用荟萃分析的方法探讨冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）对左主干和多支病变冠心病患者远期预后的影响.方法 以“angioplasty”“coronary”“coronary artery bypass surgery”“stent”为关键词,检索PubMed、Embase、Cochrane central register of controlled trials数据库,收集2013年5月之前CABG与PCI对冠心病患者（左主干和多支血管病变）远期预后影响的随机对照试验.采用STATA 12.0软件进行荟萃分析.结果 共纳入6项研究5 071例患者.荟萃分析显示：CABG组与PCI组的5年全因病死率（RR=1.13,95％ CI：0.88～ 1.44,P=0.35）、心肌梗死发生率（RR =1.20,95％ CI：0.69 ～ 2.07,P=0.53）及心绞痛发生率（RR=1.17,95％CI：0.88～1.57,P=0.28）差异无统计学意义.PCI组主要不良心脑血管事件发生率（RR=1.85,95％ CI：1.38～ 2.48,P＜0.01）及重复血运重建率（RR=3.48,95％ CI：2.20～5.53,P＜0.01）均高于CABG组.结论 对于左主干或多支病变的冠心病患者,CABG与PCI的5年病死率相似,PCI有较高的主要不良心脑血管事件发生率及重复血运重建率.Objective To evaluate the long-term outcomes of coronary artery disease patients with left main stem and/or multi-vessel disease receiving percutaneous coronary intervention （PCI） or coronary artery bypass graft （CABG）.Methods PubMed,EMBase,Cochrane central register of controlled trials were searched to identify randomized controlled trials concerning the long-term outcomes of PCI and CABG in coronary artery disease patients with left main stem and/or multi-vessel disease before May 2013.Keywords included “angioplasty”,“coronary”,“coronary artery bypass surgery” and “stent”.The data were analyzed by STATA 12.0.Results Six randomized controlled trials （5 071 patients）were enrolled for analyses.Five years all-cause mortality （RR =1.13,95％ CI：0.88-1.44,P =0.35）,incidence of myocardial infarction （RR=1.20,95％CI：0.69-2.07,P=0.53）,and angina （RR=1.17,95％CI：0.88-1.57,P=0.28）were similar between PCI and CABG groups.Major adverse cardiac and cerebrovascular event （RR =1.85,95％ CI：1.38-2.48,P ＜ 0.01） and repeat revascularization （RR =3.48,95％ CI：2.20-5.53,P ＜0.01） were significantly higher in PCI compared to CABG.Conclusions The present analysis suggests that 5 years all-cause mortality is similar between PCI and CABG strategies.However,PCI is associated with higher major adverse cardiac and cerebrovascular event and repeat revascularization rate compared to CABG in patients with unprotected left main stem and/or multi-vessel disease.

关 键 词：心脏外科手术 血管成形术 经腔 经皮冠状动脉 Meta分析 

分 类 号：R654.2[医药卫生—外科学]