摘要
目的系统评价微创冠状动脉旁路移植术(MIDCAB)与经皮冠状动脉介入术(PCI)治疗前降支近端单支病变的有效性和安全性。方法计算机检索The Cochrane Library(2015年2期)、Pub Med、EMbase、CBM、CNKI、Wan Fang Data和VIP数据库,搜集有关MIDCAB与PCI治疗前降支近端单支病变的随机对照试验(RCT),检索时限均为从建库至2015年10月。由2位评价者独立筛选文献、提取资料和评价纳入研究偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入10个RCT,共1 489例患者,其中MIDCAB组720例,PCI组769例。Meta分析结果显示:与PCI组相比,MIDCAB组可明显降低术后靶血管再次血运重建发生率[OR=0.20,95%CI(0.13,2.29),P<0.000 01]及术后主要心脑血管不良事件发生率[OR=0.44,95%CI(0.33,0.58),P<0.000 01]。但是,在全因死亡率[OR=1.23,95%CI(0.83,1.83),P=0.31]、心源性死亡率[OR=1.12,95%CI(0.59,2.12),P=0.73]及术后心肌梗死发生率[OR=2.16,95%CI(0.83,5.59),P=0.11]方面,两组无明显差异。结论当前证据显示,对于前降支近端单支病变的治疗,在降低术后靶血管再次血运重建发生率及术后主要心脑血管不良事件发生率方面,MIDCAB优于PCI。受纳入研究质量和数量的限制,上述结论仍需开展更多高质量的RCT加以验证。
Objective To systematically review the efficacy and safety of minimally invasive direct coronary artery bypass （MIDCAB） grafting versus percutaneous coronary intervention （PCI） for patients with single-vessel disease of the left anterior descending artery （LAD）. Methods Databases including The Cochrane Library （Issue 2, 2015）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to Oct. 2015, to collect randomized controlled trials （RCTs） about MIDCAB versus PCI for single-vessel disease of the LAD. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs including 1 489 patients were included. The results of meta-analysis showed that： compared with the PCI group, the MIDCAB group could significantly reduce the incidence of postoperative target vessel revascularization （OR=0.20, 95%CI 0.13 to 2.29, P〈0.000 01）, and the incidence of main adverse cardiovascular and cerebrovascular events （MACCE） （OR=0.44, 95%CI 0.33 to 0.58, P〈0.000 01）. No significant differences were found between the two groups in total case mortality （OR=1.23, 95%CI 0.83 to 1.83, P=0.31）, cardiogenic death （OR=1.12, 95%CI 0.59 to 2.12, P=0.73）, and the incidence of postoperative myocardial infarction （OR=2.16, 95%CI 0.83 to 5.59, P=0.11）. Conclusion In reducing the incidences of postoperative target vessels again revascularization and MACCE of patients with single-vessel disease of the LAD, MIDCAB is superior to PCI. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
出处
《中国循证医学杂志》
CSCD
2016年第6期698-705,共8页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金(编号:81460755)
关键词
冠状动脉旁路移植术
经皮冠状动脉介入术
前降支
微创
系统评价
META分析
随机对照试验
Percutaneous coronary intervention （PCI）
Coronary artery bypass grafting （CABG）
left descending artery （LDA）
minimally invasive
Systematic review
Meta-analysis
Randomized controlled trial
