摘要
目的系统评价冠状动脉旁路移植术(CABG)与经皮冠状动脉支架置入术(PCI)治疗无保护左主干病变的疗效及安全性。方法计算机检索he Cochrane Library(2012年第2期)、PubMed、EMbase、CBM、CNKI、WanFang Data、VIP等数据库,全面收集CABG与PCI比较治疗无保护左主干病变的随机对照试验(RCT),检索时限均为建库至2012年9月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果纳入4个RCT,共1 611例患者(CABG组:802例,PCI组:809例)。Meta分析结果显示:与PCI组相比,CABG组能显著降低术后靶血管血运重建率[OR=0.45,95%CI(0.31,0.66),P<0.000 1],但在降低心肌梗死发生率[OR=1.28,95%CI(0.47,3.48),P=0.63]、病死率[OR=1.36,95%CI(0.80,2.34),P=0.26]及主要心脑血管事件发生率[OR=0.92,95%CI(0.66,1.28),P=0.61]方面,两组差异无统计学意义。结论本系统评价结果提示,CABG在降低冠心病无保护左主干病变患者心梗发生率、病死率及主要心脑血管事件发生率方面与PCI差异无统计学意义,但在降低术后靶血管血运重建率方面,CABG疗效优于PCI。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 effectiveness and safety of coronary artery bypass grafting （CABG） versus percutaneous coronary stent implantation （PCI） in the treatment of patients with unprotected left main coronary artery disease （ULMCA）.
Methods Databases including The Cochrane Library （Issue 2, 2012）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting （CABG） versus percutaneous coronary stent implantation （PCI） for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0.
Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that： comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate （OR=0.45, 95%CI 0.31 to 0.66, P〈0.000 1）, but there was no significant difference between the two groups in reducing the myocardial infarction incidence （OR=1.28, 95%CI 0.47 to 3.48, P=0.63）, mortality rate （OR=1.36, 95%CI 0.80 to 2.34, P=0.26）, and the incidence of major adverse cardio-cerebral vascular events （OR=0.92, 95%CI 0.66 to 1.28, P=0.61）.
Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
出处
《中国循证医学杂志》
CSCD
2013年第9期1096-1101,共6页
Chinese Journal of Evidence-based Medicine
