Aziz Omer, Rao Christopher, Panesar Sukhmeet Singh, Jones Catherine, Morris Stephen, Darzi Ara, Athanasiou Thanos
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London W2 1NY.
BMJ. 2007 Mar 24;334(7594):617. doi: 10.1136/bmj.39106.476215.BE. Epub 2007 Mar 2.
To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery.
Meta-analysis of randomised and non-randomised comparative peer reviewed publications.
Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005).
Studies comparing the two procedures as the primary intervention for isolated left anterior descending artery stenosis were identified and the following extracted: study design, population characteristics, severity of coronary artery disease, cardiovascular risk factors, and outcomes of interest.
12 studies (1952 patients) reporting results from eight groups were included: one was a retrospective design, one prospective non-randomised, and six prospective randomised. Meta-analysis of randomised trials showed a higher rate of recurrence of angina (odds ratio 2.62, 95% confidence interval 1.32 to 5.21), incidence of major adverse coronary and cerebral events (2.86, 1.62 to 5.08), and need for repeat revascularisation (4.63, 2.52 to 8.51) with percutaneous stenting. No significant difference was found in myocardial infarction, stroke, or mortality at maximum follow-up between interventions.
Minimally invasive left internal thoracic artery bypass for isolated lesions of the left anterior descending artery resulted in fewer complications in the mid-term compared with percutaneous transluminal coronary artery stenting.
比较微创左胸廓内动脉搭桥术与经皮冠状动脉支架置入术作为左前降支孤立病变的主要干预措施的疗效。
对随机和非随机比较的同行评审出版物进行荟萃分析。
Embase、Medline、Cochrane、谷歌学术和卫生技术评估数据库（1966 - 2005年）。
确定比较这两种手术作为左前降支孤立狭窄主要干预措施的研究，并提取以下信息：研究设计、人群特征、冠状动脉疾病严重程度、心血管危险因素和感兴趣的结局。
纳入了12项研究（1952例患者），报告了8组结果：1项为回顾性设计，1项为前瞻性非随机研究，6项为前瞻性随机研究。随机试验的荟萃分析显示，经皮支架置入术的心绞痛复发率较高（优势比2.62，95%置信区间1.32至5.21）、主要不良冠状动脉和脑血管事件发生率较高（2.86，1.62至5.08）以及需要再次血运重建的比例较高（4.63，2.52至8.51）。在最大随访时，干预措施之间的心肌梗死、中风或死亡率没有显著差异。
对于左前降支孤立病变，与经皮冠状动脉腔内支架置入术相比，微创左胸廓内动脉搭桥术在中期并发症更少。
