药物洗脱支架或冠状动脉旁路移植术治疗无保护左主干冠状动脉疾病：四项随机试验和十七项观察性研究的荟萃分析。
Drug-eluting stents or coronary artery bypass grafting for unprotected left main coronary artery disease: a meta-analysis of four randomized trials and seventeen observational studies.
机构信息
Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021 Guangxi, People's Republic of China.
出版信息
Trials. 2013 May 8;14:133. doi: 10.1186/1745-6215-14-133.
BACKGROUND
The clinical application of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) is still controversial. The purpose of this meta-analysis was to compare the safety and efficacy between DES and CABG for ULMCAD.
METHODS
Databases of MEDLINE, EMBASE and the Cochrane Library were systematically searched.
RESULTS
Twenty-one studies with 8,413 patients were included in this meta-analysis. The risk was lower in DES than in CABG groups at the early outcomes of death (risk ratio (RR): 0.49, 95% confidence interval (CI): 0.30-0.78), cerebrovascular events (RR: 0.19, 95% CI: 0.08-0.45) and composite endpoint (RR: 0.53, 95% CI: 0.40-0.70); death after 2 years (RR: 0.81, 95% CI: 0.66-0.99), 4 years (RR: 0.69, 95% CI: 0.53-0.90), 5 years (OR: 0.76, 95% CI: 0.61-0.95) and their total effect (RR: 0.79, 95% CI: 0.71-0.87); composite endpoint 1 year (RR: 0.69, 95% CI: 0.58-0.83), 4 years (RR: 0.69, 95% CI: 0.53-0.88), 5 years (RR: 0.74, 95% CI: 0.59-0.92) and their total effect (RR: 0.78, 95% CI: 0.71-0.85). There were no significant differences in the risk for the early outcomes of myocardial infarction (RR: 0.97, 95% CI: 0.68-1.38), death 1 year (OR: 0.81, 95% CI: 0.57-1.15) and 3 years (OR: 0.85, 95% CI: 0.69-1.04), composite endpoint of 2 years (RR: 0.88, 95% CI: 0.72-1.09) and 3 years (RR: 0.87, 95% CI: 0.73-1.04). Nonetheless, there was a lower risk for revascularization associated with CABG from 1 to 5 years and their total effect (RR: 3.77, 95% CI: 3.35-4.26). There was no difference in death, myocardial infarction, cerebrovascular events or revascularization at 1 year between RCT and observational groups.
CONCLUSIONS
Our meta-analysis indicates that DES has higher safety but higher revascularization than CABG in patients with ULMCAD in the 5 years after intervention.
背景
药物洗脱支架（DES）或冠状动脉旁路移植术（CABG）治疗无保护左主干冠状动脉疾病（ULMCAD）的临床应用仍存在争议。本荟萃分析的目的是比较 DES 和 CABG 治疗 ULMCAD 的安全性和疗效。
方法
系统检索 MEDLINE、EMBASE 和 Cochrane 图书馆数据库。
结果
本荟萃分析纳入了 21 项研究，共 8413 例患者。DES 组早期结局的死亡率（风险比（RR）：0.49，95%置信区间（CI）：0.30-0.78）、脑血管事件（RR：0.19，95%CI：0.08-0.45）和复合终点（RR：0.53，95%CI：0.40-0.70）的风险低于 CABG 组；2 年（RR：0.81，95%CI：0.66-0.99）、4 年（RR：0.69，95%CI：0.53-0.90）、5 年（OR：0.76，95%CI：0.61-0.95）和总效应（RR：0.79，95%CI：0.71-0.87）的死亡率；复合终点 1 年（RR：0.69，95%CI：0.58-0.83）、4 年（RR：0.69，95%CI：0.53-0.88）、5 年（RR：0.74，95%CI：0.59-0.92）和总效应（RR：0.78，95%CI：0.71-0.85）的风险较低。早期心肌梗死（RR：0.97，95%CI：0.68-1.38）、1 年死亡率（OR：0.81，95%CI：0.57-1.15）和 3 年死亡率（OR：0.85，95%CI：0.69-1.04）、2 年复合终点（RR：0.88，95%CI：0.72-1.09）和 3 年复合终点（RR：0.87，95%CI：0.73-1.04）的风险无显著差异。然而，从 1 年到 5 年，CABG 组的血运重建风险及其总效应（RR：3.77，95%CI：3.35-4.26）较低。随机对照试验和观察性研究组在 1 年时的死亡率、心肌梗死、脑血管事件或血运重建无差异。
结论
本荟萃分析表明，在介入治疗后 5 年内，DES 治疗 ULMCAD 的安全性高于 CABG，但血运重建率较高。
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