多支血管病变患者完全血运重建与不完全血运重建的结局比较：随机临床试验和观察性研究中 89883 例患者的荟萃分析。
Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies.
机构信息
Division of Cardiology, Department of Medicine, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
出版信息
J Am Coll Cardiol. 2013 Oct 15;62(16):1421-31. doi: 10.1016/j.jacc.2013.05.033. Epub 2013 Jun 7.
OBJECTIVES
This study sought to perform a systematic review and meta-analysis of studies comparing complete revascularization (CR) versus incomplete revascularization (IR) in patients with multivessel coronary artery disease.
BACKGROUND
There are conflicting data regarding the benefits of CR in patients with multivessel coronary artery disease.
METHODS
We identified observational studies and subgroup analysis of randomized clinical trials (RCT) published in PubMed from 1970 through September 2012 using the following keywords: "percutaneous coronary intervention" (PCI); "coronary artery bypass graft" (CABG); "complete revascularization"; and "incomplete revascularization." Main outcome measures were total mortality, myocardial infarction, and repeat revascularization procedures.
RESULTS
We identified 35 studies including 89,883 patients, of whom 45,417 (50.5%) received CR and 44,466 (49.5%) received IR. IR was more common after PCI than after CABG (56% vs. 25%; p < 0.001). Relative to IR, CR was associated with lower long-term mortality (risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.65 to 0.77; p < 0.001), myocardial infarction (RR: 0.78, 95% CI: 0.68 to 0.90; p = 0.001), and repeat coronary revascularization (RR: 0.74, 95% CI: 0.65 to 0.83; p < 0.001). The mortality benefit associated with CR was consistent across studies irrespective of revascularization modality (CABG: RR: 0.70, 95% CI: 0.61 to 0.80; p < 0.001; and PCI: RR: 0.72, 95% CI: 0.64 to 0.81; p < 0.001) and definition of CR (anatomic definition: RR: 0.73, 95% CI: 0.67 to 0.79; p < 0.001; and nonanatomic definition: RR: 0.57, 95% CI: 0.36 to 0.89; p = 0.014).
CONCLUSIONS
CR is achieved more commonly with CABG than with PCI. Among patients with multivessel coronary artery disease, CR may be the optimal revascularization strategy.
目的
本研究旨在对比较多支冠状动脉疾病患者完全血运重建（CR）与不完全血运重建（IR）的研究进行系统评价和荟萃分析。
背景
关于多支冠状动脉疾病患者进行 CR 的获益，目前仍存在相互矛盾的数据。
方法
我们在 PubMed 中使用以下关键字检索了 1970 年至 2012 年 9 月发表的观察性研究和随机临床试验（RCT）的亚组分析：“经皮冠状动脉介入治疗”（PCI）；“冠状动脉旁路移植术”（CABG）；“完全血运重建”；和“不完全血运重建”。主要观察终点是全因死亡率、心肌梗死和再次血运重建。
结果
我们共纳入了 35 项研究，共 89883 例患者，其中 45417 例（50.5%）接受了 CR，44466 例（49.5%）接受了 IR。PCI 后 IR 比 CABG 后更为常见（56% vs. 25%；p<0.001）。与 IR 相比，CR 与长期死亡率降低相关（风险比[RR]：0.71，95%置信区间[CI]：0.65 至 0.77；p<0.001）、心肌梗死（RR：0.78，95%CI：0.68 至 0.90；p=0.001）和再次冠状动脉血运重建（RR：0.74，95%CI：0.65 至 0.83；p<0.001）。无论血运重建方式（CABG：RR：0.70，95%CI：0.61 至 0.80；p<0.001；和 PCI：RR：0.72，95%CI：0.64 至 0.81；p<0.001）和 CR 的定义（解剖学定义：RR：0.73，95%CI：0.67 至 0.79；p<0.001；和非解剖学定义：RR：0.57，95%CI：0.36 至 0.89；p=0.014）如何，CR 与死亡率降低均相关。
结论
CABG 比 PCI 更常实现 CR。在多支冠状动脉疾病患者中，CR 可能是最佳的血运重建策略。
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