摘要
目的比较经皮冠状动脉介入术(PCI)与冠状动脉旁路移植术(CABG)对无保护左主干病变(ULMCA)的疗效,从而探讨ULMCA的最佳血运重建方法。方法通过检索Medline、中国生物医学文献数据库系统、中国期刊全文数据库、维普数据库、万方数据库,收集国内外公开发表的关于ULMCA行PCI与CABG术后随访期内心脑血管不良事件发生率(MACCE)及靶血管血运重建率(TVR)比较的随机对照试验,应用STATA11.0统计学软件对结果进行分析。研究人群为经冠状动脉造影确诊的ULMCA病变患者,干预措施为CABG术或PCI术,结局指标包括:随访期内MACCE和TVR,分别以比值比(OR)及95%可信区间(CI)作为效应指标对结局进行比较。结果最终纳入文献10篇,共20417例患者,PCI组与CABG组的MACCE发生率OR为1.32(1.18～1.47,Z=4.89,P=0.000),按照随访时间分层后随访24个月内两种处理方法的术后MACCE发生率无明显差异,36个月时的MACCE发生率OR为1.55(1.14～2.11,Z=2.78,P=0.005),随访48个月组的MACCE发生率OR为1.69(1.35～2.12,Z=4.56,P=0.000);PCI组与CABG组的TVR发生率OR为3.944(3.789～4.105,Z=67.26,P=0.000),按照随访时间分层后再次分析,结论较分层前未发生有意义的改变。结论 PCI与CABG在术后24个月内MACCE的发生率无明显差异,36个月后PCI组的MACCE发生率增加,是CAGB组的1.55倍,48个月时达1.69倍;PCI组术后TVR的发生率高于CABG组,是CABG组的3.944倍,分层分析后结论与分层前基本相同,即在各随访期内,PCI组的术后TVR发生率均显著高于CABG组。
Objective To explore a better method of blood reascularization for unprotected left main coronary artery （ UMLCA ）. Methods By searching Medline, China Biology Medicine （ CBM ）, China National Knowledge Infrastructure（ CNKI）, Weipu, Wanfang Database by computer,the data of randomized controlled trails of percutaneous coronary intervention（PCI） or coronary artery bypass grafting （CABG）for ULMCA were selected and analyzed using STATA 11.0 statistical software. The study population Was patients with ULMCA, the intervention was PCI or CABG, the outcome indices were 1 -year to 4-year major adverse cardiac events occurring rate and target vessel revascularization（TVR）rate. The combined odd ratio（OR） and their 95% confidence interval were calculated to estimate the results. Results 10 articles including a total of 20 417 patients were finally analyzed in the Meta- analysis. Amang the PCI group and CABG group,the OR of l-year,2-year,3-year and 4-year MACCE rate was 1.12 （0.96-1.32,Z=： 1.41,P = 0. 160）, 1.27（0.97-1.66,Z = 1.76,P =0.079）, 1.55（1.14-2. 11,Z = 2.78,P = 0. 005）and 1.69（1.35-2. 12,Z =4.56,P = 0.000）,while the OR of TVR rate was 3.944（3.789-4. 105,Z = 67. 26,P = 0. 009）. Conclusions The MACCE rate was of no difference between PCI and CABG in 2 years follow- up, but the MAC.CE rate of PCI group was 1.55 times than the CABG group in 3-year and 1.69 times in 4-year. The TVR rate of PCI group was 3. 944 times than the CABG group on average.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第8期119-123,共5页
Chinese Journal of Clinicians(Electronic Edition)
