比较经导管与外科主动脉瓣置换术联合冠状动脉血运重建治疗中、高危重度主动脉瓣狭窄合并冠状动脉疾病患者疗效的Meta分析  

A Meta-analysis of the Efficacy of Transcatheter Versus Surgical Aortic Valve Replacement Combined With Coronary Artery Revascularization in Patients With Intermediate or High Risk Severe Aortic Stenosis and Coronary Artery Disease

作　　者：张翔宇 耿巍[1] 李梦毓 闫少华 刘秋梅 张晨峰[1] ZHANG Xiangyu;GENG Wei;LI Mengyu;YAN Shaohua;LIU Qiumei;ZHANG Chenfeng(Department of Cardiology,Baoding NO.1 Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院心血管内科,保定071000

出　　处：《中国循环杂志》2024年第5期464-469,共6页Chinese Circulation Journal

基　　金：河北省保定市科技计划项目(2341ZF270)。

摘　　要：目的:比较经导管主动脉瓣置换术(TAVR)联合经皮冠状动脉介入治疗(PCI)与外科主动脉瓣置换术(SAVR)联合冠状动脉旁路移植术(CABG)治疗中、高危重度主动脉瓣狭窄合并冠状动脉疾病患者的疗效。方法:检索Embase、Medline、Cochrane图书馆、PubMed、维普网、万方数据库、中国知网等数据库中在中、高危重度主动脉瓣狭窄合并冠状动脉疾病患者中比较TAVR联合PCI与SAVR联合CABG疗效的研究,检索时间为自建库至2023年7月4日。结果:共纳入6项研究,包括1项随机对照研究和5项观察性队列研究;共纳入2 137例患者,其中TAVR+PCI组833例,SAVR+CABG组1 304例。Meta分析结果显示:与SAVR+CABG组相比,TAVR+PCI组30 d心肌梗死(OR=0.65,95%CI:0.28~1.46,P=0.29)、脑卒中(OR=0.81,95%CI:0.45~1.48,P=0.50)及随访期间急性肾损伤(OR=0.38,95%CI:0.14~1.02,P=0.05)、大出血(OR=0.66,95%CI:0.22~2.00,P=0.47)风险均未显著增加,30 d全因死亡风险(OR=0.66,95%CI:0.44~0.99,P=0.04)显著降低,但长期(≥2年)全因死亡(OR=1.47,95%CI:1.12~1.93,P=0.005)及随访期间血管并发症(OR=11.48,95%CI:2.69~48.94,P=0.001)、起搏器植入(OR=3.09,95%CI:1.68~5.68,P<0.001)风险均显著增加。结论:在中、高危重度主动脉瓣狭窄合并冠状动脉疾病患者中,与SAVR+CABG相比,TAVR+PCI显著降低30 d全因死亡风险,但会显著增加长期全因死亡及随访期间血管并发症和起搏器植入风险。Objectives:To compare the efficacy of transcatheter aortic valve replacement(TAVR)combined with percutaneous coronary intervention(PCI)versus surgical aortic valve replacement(SAVR)combined with coronary artery bypass grafting(CABG)in patients with intermediate or high risk severe aortic stenosis(AS)and coronary artery disease(CAD).Methods:Embase,Medline,the Cochrane Library,PubMed,VIP,Wanfang Database,CNKI were searched for studies comparing the efficacy of TAVR combined with PCI and SAVR combined with CABG in patients with intermediate or high risk severe aortic stenosis complicated with CAD,from the establishment of the database to July 4,2023.Results:Six studies were included,including one randomized controlled study and five observational cohort studies.A total of 2137 patients were enrolled,including 833 in the TAVR+PCI group and 1304 in the SAVR+CABG group.The results of the meta-analysis showed that compared with SAVR+CABG,TAVR+PCI did not significantly increase the risk of myocardial infarction(OR=0.65,95%CI:0.28-1.46,P=0.29),stroke(OR=0.81,95%CI:0.45-1.48,P=0.50)within 30 days and the risk of acute kidney injury(OR=0.38,95%CI:0.14-1.02,P=0.05),major bleeding(OR=0.66,95%CI:0.22-2.00,P=0.47)during follow-up,and significantly reduced all-cause mortality within 30 days(OR=0.66,95%CI:0.44-0.99,P=0.04),but significantly increased all-cause mortality(OR=1.47,95%CI:1.12-1.93,P=0.005)and vascular complications(OR=11.48,95%CI:2.69-48.94,P=0.001),pacemaker implantation(OR=3.09,95%CI:1.68-5.68,P<0.001)during long-term(≥2 years)follow-up.Conclusions:In patients with intermediate or high risk severe AS and CAD,compared with SAVR+CABG,TAVR+PCI significantly reduced the risk of all-cause mortality within 30 days,but significantly increased the risk of all-cause mortality,vascular complications,and pacemaker implantation during long-term follow-up.

关 键 词：经导管主动脉瓣置换术 外科主动脉瓣置换术 主动脉瓣狭窄 冠状动脉疾病 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]