冠状动脉旁路移植术治疗冠脉多支病变长期疗效的Meta分析  

Long-term Ef ect of Coronary Artery Bypass Grafting for Coronary Multivessel Lesions:A Meta-analysis

作　　者：李俊红[1] 木拉提[1] 阿布都乃比[1] 

机构地区：[1]新疆医科大学第一附属医院心脏外科一科,乌鲁木齐830054

出　　处：《中国循证医学杂志》2016年第4期403-408,共6页Chinese Journal of Evidence-based Medicine

基　　金：新疆维吾尔自治区自然科学基金(编号:2014211C079)

摘　　要：目的系统评价冠状动脉旁路移植术(CABG)与药物洗脱性支架植入术(DES-PCI)治疗冠脉多支病变患者的长期疗效。方法计算机检索The Cochrane Library(2015年第2期)、PubMed、EMbase、CBM、CNKI、WanFang Data和VIP数据库,搜集有关CABG与DES-PCI治疗冠脉多支病变的相关随机对照试验(RCT),检索时限均为从建库至2015年10月。由2位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入7个RCT,共5 723例患者,其中CABG组2 887例,DES-PCI组2 836例。Meta分析结果显示:与DES-PCI组比较,CABG组术后1年靶血管再次血运重建率[OR=0.39,95%CI(0.31,0.48),P<0.000 01]、术后5年病死率[OR=0.78,95%CI(0.65,0.94),P=0.008],以及术后5年心肌梗死发生率[OR=0.46,95%CI(0.37,0.58),P<0.000 01]均明显更低,但CABG组术后1年、2年及5年脑卒中发生率明显高于DES-PCI组(P均<0.05)。结论现有证据表明,CABG的长期疗效优于DES-PCI,但CABG脑卒中发生风险更高。受纳入研究质量和数量所限,上述结论仍需开展更多高质量的RCT加以验证。Objective To systematically review the long-term efficacy of coronary artery bypass grafting（CABG） versus drug-eluting stent implantation（DES-PCI） for patients with multivessel coronary artery disease. Methods We searched The Cochrane Library（Issue 2, 2015）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP to collect randomized controlled trials（RCTs） about CABG versus DES-PCI for patients with coronary multivessel disease from the inception to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.2 software. Results A total of seven RCTs, involving 5 723 patients were included. The results of meta-analysis showed that： compared with the DES-PCI group, the CABG group had lower 1-year incidence of target vessel revascularization（OR=0.39, 95%CI 0.31 to 0.48, P0.000 01）, 5-year mortality（OR=0.78, 95%CI 0.65 to 0.94, P=0.008）, and 5-year incidence of myocardial infarction（OR=0.46, 95%CI 0.37 to 0.58, P0.000 01）. However, 1-year, 2-year and 5-year incidences of stroke in the CABG group were significantly higher than that in the DES-PCI group（all P values 0.05）. Conclusion The available evidence suggests that CABG is superior to DES-PCI for patients with multivessel coronary artery disease in long-term effects, but CABG could increase the incidence of stroke. Due to the quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality RCTs.

关 键 词：冠状动脉旁路移植术 药物洗脱性支架植入术 冠脉多支病变 系统评价 META分析 随机对照试验 

分 类 号：R654.2[医药卫生—外科学]