Kapoor John R, Gienger Allison L, Ardehali Reza, Varghese Robin, Perez Marco V, Sundaram Vandana, McDonald Kathryn M, Owens Douglas K, Hlatky Mark A, Bravata Dena M
Department of Cardiology, Stanford University School of Medicine, California, USA.
JACC Cardiovasc Interv. 2008 Oct;1(5):483-91. doi: 10.1016/j.jcin.2008.07.001.
This study sought to systematically compare the effectiveness of percutaneous coronary intervention and coronary artery bypass surgery in patients with single-vessel disease of the proximal left anterior descending (LAD) coronary artery.
It is uncertain whether percutaneous coronary interventions (PCI) or coronary artery bypass grafting (CABG) surgery provides better clinical outcomes among patients with single-vessel disease of the proximal LAD.
We searched relevant databases (MEDLINE, EMBASE, and Cochrane from 1966 to 2006) to identify randomized controlled trials that compared outcomes for patients with single-vessel proximal LAD assigned to either PCI or CABG.
We identified 9 randomized controlled trials that enrolled a total of 1,210 patients (633 received PCI and 577 received CABG). There were no differences in survival at 30 days, 1 year, or 5 years, nor were there differences in the rates of procedural strokes or myocardial infarctions, whereas the rate of repeat revascularization was significantly less after CABG than after PCI (at 1 year: 7.3% vs. 19.5%; at 5 years: 7.3% vs. 33.5%). Angina relief was significantly greater after CABG than after PCI (at 1 year: 95.5% vs. 84.6%; at 5 years: 84.2% vs. 75.6%). Patients undergoing CABG spent 3.2 more days in the hospital than those receiving PCI (95% confidence interval: 2.3 to 4.1 days, p < 0.0001), required more transfusions, and were more likely to have arrhythmias immediately post-procedure.
In patients with single-vessel, proximal LAD disease, survival was similar in CABG-assigned and PCI-assigned patients; CABG was significantly more effective in relieving angina and led to fewer repeat revascularizations.
本研究旨在系统比较经皮冠状动脉介入治疗与冠状动脉旁路移植术对左前降支（LAD）近端单支血管病变患者的疗效。
对于LAD近端单支血管病变患者，经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）哪种手术方式能带来更好的临床结局尚不确定。
我们检索了相关数据库（1966年至2006年的MEDLINE、EMBASE和Cochrane数据库），以确定比较接受PCI或CABG的LAD近端单支血管病变患者结局的随机对照试验。
我们确定了9项随机对照试验，共纳入1210例患者（633例接受PCI，577例接受CABG）。30天、1年或5年的生存率无差异，手术相关中风或心肌梗死发生率也无差异，而CABG术后再次血运重建率明显低于PCI术后（1年时：7.3%对19.5%；5年时：7.3%对33.5%）。CABG术后心绞痛缓解情况明显优于PCI术后（1年时：95.5%对84.6%；5年时：84.2%对75.6%）。接受CABG的患者住院时间比接受PCI的患者多3.2天（95%置信区间：2.3至4.1天，p<0.0001），需要更多输血，且术后立即发生心律失常的可能性更大。
对于LAD近端单支血管病变患者，接受CABG和PCI的患者生存率相似；CABG在缓解心绞痛方面明显更有效，且再次血运重建较少。
