Bainbridge Daniel, Cheng Davy, Martin Janet, Novick Richard
Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):623-31. doi: 10.1016/j.jtcvs.2006.11.019.
To determine, through meta-analysis, whether off-pump coronary artery bypass, including minimally invasive off-pump coronary artery bypass, improves short-term and midterm outcomes compared with percutaneous coronary intervention for single- or double-vessel coronary artery disease.
The primary outcome was need for coronary reintervention at 1 to 5 years. Secondary outcomes included all major clinical morbidities and resource utilization. A comprehensive search was undertaken to identify all randomized trials of off-pump coronary artery bypass versus percutaneous coronary intervention. MEDLINE, Cochrane Library, EMBASE, and abstract databases were searched up to May 2006. All randomized trials comparing off-pump coronary artery bypass (sternotomy or minimally invasive) versus percutaneous coronary intervention and reporting at least one predefined outcome were included. Odds ratios (OR, 95% confidence intervals [CI]) and weighted mean differences (WMD, 95% CI) were analyzed.
Six trials involving 989 patients were included. Compared with percutaneous coronary intervention, off-pump coronary artery bypass decreased angina recurrence (OR 0.54, 95% CI 0.34-0.87) and need for reintervention at 1 to 5 years (OR 0.24, 95% CI 0.15-0.40). Major adverse coronary events were significantly reduced (OR 0.44, 95% CI 0.30-0.63) and event-free survival was significantly increased at 1 to 5 years (OR 2.32, 95% CI 1.62-3.32) for off-pump coronary artery bypass versus percutaneous coronary intervention. Coronary stenosis at 6 months was reduced with off-pump coronary artery bypass compared with percutaneous coronary intervention (OR 0.31, 95% CI 0.18-0.55). Hospital stay was significantly increased with off-pump coronary artery bypass versus percutaneous coronary intervention (WMD 4.03, 95% CI 2.37-5.70). Quality of life favored off-pump coronary artery bypass in some domains but was reported in few studies. Death, myocardial infarction, and stroke did not significantly differ.
In single- or double-vessel disease, off-pump coronary artery bypass improved short-term and midterm clinical outcomes compared with percutaneous coronary intervention but was associated with an increased length of hospital stay.
通过荟萃分析确定非体外循环冠状动脉搭桥术，包括微创非体外循环冠状动脉搭桥术，与经皮冠状动脉介入治疗相比，在治疗单支或双支冠状动脉疾病时是否能改善短期和中期预后。
主要结局是1至5年时冠状动脉再次介入治疗的需求。次要结局包括所有主要临床并发症和资源利用情况。进行全面检索以识别所有非体外循环冠状动脉搭桥术与经皮冠状动脉介入治疗的随机试验。检索MEDLINE、Cochrane图书馆、EMBASE和摘要数据库至2006年5月。纳入所有比较非体外循环冠状动脉搭桥术（胸骨切开术或微创）与经皮冠状动脉介入治疗并报告至少一项预定义结局的随机试验。分析比值比（OR，95%置信区间[CI]）和加权平均差（WMD，95%CI）。
纳入6项试验，共989例患者。与经皮冠状动脉介入治疗相比，非体外循环冠状动脉搭桥术降低了心绞痛复发率（OR 0.54，95%CI 0.34 - 0.87）以及1至5年时再次介入治疗的需求（OR 0.24，95%CI 0.15 - 0.40）。非体外循环冠状动脉搭桥术与经皮冠状动脉介入治疗相比，主要不良冠状动脉事件显著减少（OR 0.44，95%CI 0.30 - 0.63），且1至5年无事件生存率显著提高（OR 2.32，95%CI 1.62 - 3.32）。与经皮冠状动脉介入治疗相比，非体外循环冠状动脉搭桥术使6个月时的冠状动脉狭窄程度降低（OR 0.31，95%CI 0.18 - 0.55）。与经皮冠状动脉介入治疗相比，非体外循环冠状动脉搭桥术使住院时间显著延长（WMD 4.03，95%CI 2.37 - 5.70）。在某些领域，生活质量更倾向于非体外循环冠状动脉搭桥术，但相关研究报道较少。死亡、心肌梗死和中风方面无显著差异。
在单支或双支血管疾病中，与经皮冠状动脉介入治疗相比，非体外循环冠状动脉搭桥术改善了短期和中期临床结局，但与住院时间延长相关。
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