摘要
目的比较经皮冠状动脉介入治疗(PCI)、冠状动脉旁路移植术(CABG)和最佳药物治疗(OMT)对冠状动脉慢性完全闭塞(CTO)病变的疗效。方法计算机检索PubMed、EMBASE、The Cochrane Library、CNKI、VIP、ChiCTR和WanFang Data数据库,搜集关于PCI、CABG和OMT治疗CTO病变疗效比较的队列研究和随机对照试验(RCT)。检索时限均为建库至2021年12月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R3.6.2软件进行网状Meta分析。结果共纳入33项研究,涉及29项队列研究和4项RCT,共计21889例患者。在主要不良心血管事件(MACE)发生率方面,三种治疗概率排序第一位的是PCI(53%),第二位是CABG(47%),第三位是OMT(92%);在全因死亡(ACM)发生率方面,三种治疗排序第一位的是CABG(92%),第二位是PCI(92%),第三位是OMT(100%);在血运重建(RV)发生率方面,三种治疗排序第一位的是CABG(100%),PCI(50%)和OMT(50%)并列第二位;在心肌梗死(MI)发生率方面,三种治疗排序第一位的是CABG(98%),第二位是PCI(97%),第三位是OMT(99%);在心原性死亡(CM)发生率方面,三种治疗排序中第一位概率最高的是PCI(90%),第二位是CABG(90%),第三位是OMT(100%);在主要不良心脑血管事件(MACCE)发生率方面,三种治疗排序第一位的是CABG(59%),第二位是PCI(58%),第三位是OMT(95%)。CTO病变三种治疗方式的累积排序曲线下面积(SUCRA)显示:对于ACM、RV、MI和MACCE发生率,CABG>PCI>OTM;对于MACE和CM发生率,PCI>CABG>OTM。结论PCI能降低CTO病变患者MACE和CM发生率,疗效排在第一位;CABG能降低CTO病变患者ACM、RV、MI和MACCE发生率,疗效排在第一位。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To compare the efficacy of percutaneous coronary intervention(PCI),coronary artery bypass grafting(CABG)and optimal medication treatment(OMT)for chronic total occlusion(CTO)patients.Methods PubMed,EMBASE,The Cochrane Library,CNKI,VIP,ChiCTR,and WanFang Data databases were electronically searched to collect cohort studies and randomized controlled trials(RCTs)on efficacy of PCI,CABG and OMT for CTO until December 1st,2021.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies.Then,network meta-analysis was performed by using R3.6.2 software.Results A total of 33 studies involving 29 cohort studies and 4 RCTs with 21889 patients were included.The results of network meta-analysis showed that:in terms of the incidence of major adverse cardiovascular events(MACE),among the efficacy of the three treatments,PCI ranked first(53%),CABG ranked second(47%),and OMT ranked third(92%);in terms of the incidence of all-cause mortality(ACM),among the efficacy of the three treatments,CABG ranked first(92%),PCI ranked second(92%),and OMT ranked third(100%);in terms of the incidence of revascularization(RV),among the efficacy of the three treatments,CABG ranked first(100%),PCI and OMT tied for ranked second(50%);in terms of the incidence of myocardial infarction(MI),among the efficacy of the three treatments,CABG ranked first(98%),PCI ranked second(97%),and OMT ranked third(99%);in terms of the incidence of cardiac mortality(CM),among the efficacy of the three treatments,PCI ranked first(90%),CABG ranked second(90%),and OMT ranked third(100%);in terms of the incidence of major adverse cardiovascular and cerebrovascular events(MACCE),among the efficacy of the three treatments,CABG ranked first(59%),PCI ranked second(58%),and OMT ranked third(95%).The surface under the cumulative ranking curve(SUCRA)of three treatment measures for CTO showed that:for the incidence of ACM,RV,MI and MACCE,CABG>PCI>OTM;for the incidence of MACE and CM,PCI>CABG>OTM.Conclusions Current evidence shows that PCI can reduce the incidence of MACE and CM in CTO patients,and the efficacy ranked first;CABG can reduce the incidence of ACM,RV,MI and MACCE in CTO patients,and the efficacy ranked first.Due to limited quality and quantity of the included studies,more high quality studies are required to verify above conclusion.
作者
王凯阳
宁怡
闵轩
谢翔
WANG Kai-yang;NING Yi;MIN Xuan;XIE Xiang(Department of Cardiology,the First Affi liated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中国介入心脏病学杂志》
CSCD
2023年第1期51-62,共12页
Chinese Journal of Interventional Cardiology
基金
国家自然科学基金面上项目(82170345)。
