药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉左前降支狭窄安全性和疗效比较的系统评价  

Safety and effectiveness of drug-eluting stent versus coronary artery bypass grafting for left anterior descending coronary artery stenosis: a systematic review

作　　者：侯量[1] 尹来波[1] 朱佳龙[1] 朱志军[1] 胡思远[1] 

机构地区：[1]石河子大学医学院第一附属医院心胸外一科,新疆石河子832008

出　　处：《军事医学》2017年第6期524-529,共6页Military Medical Sciences

摘　　要：目的系统评价药物洗脱支架(DES)与冠状动脉旁路移植术(CABG)治疗冠状动脉左前降支(LAD)狭窄的疗效和安全性。方法计算机检索Pub Med、The Cochrane Library、MEDLINE、EMbase、VIP、CNKI和Wan Fang Data数据库,检索时限均为从建库至2016年11月,纳入有关DES与CABG治疗LAD狭窄的疗效和安全性文献。由2名评价员按照纳入与排除标准独立筛选文献、提取资料和评价质量,采用Rev Man 5.3软件进行荟萃分析。结果共纳入3个随机对照试验,7个队列研究,共9771例患者。荟萃分析结果显示:在病死率[RR=0.88,95%CI(0.70,1.11),P=0.28]、主要心血管不良事件发生率[MACE,RR=1.04,95%CI(0.88,1.24),P=0.63]、心肌梗死发生率[RR=0.92,95%CI(0.56,1.53),P=0.75]方面两组差异无统计学意义,但在靶血管重建率(TVR)方面两组差异有统计学意义[RR=2.43,95%CI(1.61,3.69),P<0.0001]。结论在冠脉LAD狭窄治疗中,对比CABG,DES具有相似的病死率、心血管不良事件发生率和心梗发生率,但其显著增高了TVR,在临床应用中需慎重选择治疗方案。Objective To systematically review the efficacy and safety of drug-eluting stent（ DES） versus coronary artery bypass grafting（ CABG） in the treatment of left anterior descending coronary artery（ CAD） stenosis. Methods Literature about the efficacy and safety of DES versus CABG for LAD stenosis was retrieved from digital databases of MEDLINE,EMbase,Pub Med,and the Cochrane Library by November 2016. Data extraction and quality assessment of included studies were conducted by two independent reviewers. Rev Man 5. 3 software was used to perform meta-analysis.Results Ten studies involving 9771 patients were finally included. The results of meta-analysis showed that there was no significant difference in mortality [RR = 0. 88,95% CI（ 0. 70,1. 11）,P = 0. 28 ],major adverse cardiovascular events[MACE,RR = 1. 04,95% CI（ 0. 88,1. 24）,P = 0. 63] or myocardial infarction [MI,RR = 0. 92,95% CI（ 0. 56,1. 53）,P = 0. 75],but PCI-DES significantly increased the risk of TVR [OR = 2. 43,95% CI（ 1. 61,3. 69）,P 〈0. 0001].Conclusion For LAD stenosis,PCI-DES strategy causes as high a rate of mortality,MACE and MI as CABG or DES,but PCI-DES can significantly increase the risk of TVR,so we should be cautious clinically.

关 键 词：冠心病 药物洗脱支架 冠状动脉旁路移植术 左前降支病变 荟萃分析 系统评价 

分 类 号：R654.2[医药卫生—外科学]