Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada.
Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
JACC Cardiovasc Interv. 2014 May;7(5):497-506. doi: 10.1016/j.jcin.2013.12.202. Epub 2014 Apr 16.
This study sought to compare the efficacy of coronary artery bypass graft surgery (CABG) to that of percutaneous coronary intervention (PCI) with first-generation drug-eluting stents among patients with multivessel disease (MVD), unprotected left main (LM) disease, and single-vessel proximal left anterior descending (LAD) disease.
The efficacy and safety of CABG versus PCI with drug-eluting stents in patient subgroups remains controversial.
We systematically searched Cardiosource, Circulation, Clinicaltrials.gov, the Cochrane Library, EMBASE, and Medline for articles published through June 2013 for randomized controlled trials comparing CABG with PCI. Primary endpoints included mortality, myocardial infarction, revascularization, and stroke. Data were meta-analyzed with random-effects models.
We identified 7 randomized controlled trials (N = 5,835): 2 of MVD (n = 2,410, 100% diabetic), 2 of LM disease (n = 1,206, 29.0% diabetic), 1 of 3-vessel or LM disease (n = 1,900, 25.5% diabetic), and 2 of single-vessel proximal LAD disease (n = 319, 36.3% diabetic). In MVD patients, CABG reduced the risk of mortality (risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.57 to 0.87), myocardial infarction (RR: 0.47, 95% CI: 0.36 to 0.61), and repeat revascularization (RR: 0.36, 95% CI: 0.24 to 0.52), but increased stroke risk (RR: 1.72, 95% CI: 1.02 to 2.90). In patients with LM disease, CABG reduced revascularization risk (RR: 0.60, 95% CI: 0.46 to 0.78) and increased stroke risk (RR: 2.89, 95% CI: 1.15 to 7.27). Data for patients with single-vessel proximal LAD disease were inconclusive.
CABG is more efficacious than is PCI with first-generation drug-eluting stents in patients with LM and MVD, at the cost of increased rates of stroke. No conclusion can be drawn for patients with single-vessel proximal LAD disease.
本研究旨在比较冠状动脉旁路移植术（CABG）与第一代药物洗脱支架经皮冠状动脉介入治疗（PCI）治疗多支血管疾病（MVD）、无保护左主干（LM）疾病和单支血管近端左前降支（LAD）疾病的疗效。
CABG 与药物洗脱支架 PCI 在患者亚组中的疗效和安全性仍存在争议。
我们通过 Cardiosource、Circulation、Clinicaltrials.gov、Cochrane 图书馆、EMBASE 和 Medline 系统地检索了截至 2013 年 6 月发表的比较 CABG 与 PCI 的随机对照试验的文章。主要终点包括死亡率、心肌梗死、血运重建和卒中等。采用随机效应模型进行荟萃分析。
我们确定了 7 项随机对照试验（N=5835）：2 项 MVD 研究（n=2410，100%为糖尿病患者）、2 项 LM 疾病研究（n=1206，29.0%为糖尿病患者）、1 项 3 支血管或 LM 疾病研究（n=1900，25.5%为糖尿病患者）和 2 项单支血管近端 LAD 疾病研究（n=319，36.3%为糖尿病患者）。在 MVD 患者中，CABG 降低了死亡率（风险比 [RR]：0.70，95%置信区间 [CI]：0.57 至 0.87）、心肌梗死（RR：0.47，95%CI：0.36 至 0.61）和再次血运重建（RR：0.36，95%CI：0.24 至 0.52）的风险，但增加了卒中风险（RR：1.72，95%CI：1.02 至 2.90）。在 LM 疾病患者中，CABG 降低了血运重建风险（RR：0.60，95%CI：0.46 至 0.78）和卒中风险（RR：2.89，95%CI：1.15 至 7.27）。对于单支血管近端 LAD 疾病患者的数据尚无定论。
CABG 比第一代药物洗脱支架 PCI 在 LM 和 MVD 患者中更有效，但卒中发生率增加。对于单支血管近端 LAD 疾病患者，无法得出结论。
