根据既往冠状动脉旁路移植术对急性冠脉综合征预后的影响：荟萃分析。

Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis.

作者信息

Teixeira Rogério, Vieira Maria J, Ribeiro Miguel A, Gonçalves Lino, Gersh Bernard J

机构信息

Departamento de Medicina, Serviço de Cardiologia, Hospital Beatriz Ângelo, Loures, Portugal Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.

出版信息

Eur Heart J Acute Cardiovasc Care. 2015 Dec;4(6):518-27. doi: 10.1177/2048872614554110. Epub 2014 Oct 7.

DOI:10.1177/2048872614554110

PMID:25293725

Abstract

PURPOSE

Conduct a meta-analysis to study the prognostic influence of a previous coronary artery bypass grafting (CABG) in patients admitted for an acute coronary syndrome (ACS).

METHODS

A systematic review of the literature was performed using electronic reference databases through January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar and references cited in other studies). Studies in which ACS outcomes with a previous history of CABG were compared with ACS outcomes with no history of previous CABG were considered for inclusion. The main endpoints of interest were mortality and non-fatal acute myocardial infarction. Data was aggregated at three follow-up times using random-effects meta-analysis models.

RESULTS

Twenty-four studies were included which provided 387,181 patients for analysis. Previous CABG ACS patients were older, more diabetic and had a more frequent history of a previous myocardial infarction. Pooled in-hospital mortality was higher for the previous CABG ACS patients (OR 1.22 [1.04-1.44], p<0.01, I(2) 88%). The pooled adjusted OR showed no significant differences for the two groups (adjusted OR 1.13 [0.93-1.37], p=0.22, I(2) 92%). Previous CABG ACS patient had a higher pooled 30-day mortality (OR 1.28 [1.05-1.55], p=0.02, I(2) 74%); a higher non-adjusted (OR 1.61 [1.38-1.88], p<0.01, I(2) 70%) and adjusted (adjusted OR 1.37 [1.15-1.65], p<0.01, I(2) 0%) long-term mortality. Both the in-hospital and the long-term re-infarction rates were higher for the previous CABG ACS patients.

CONCLUSIONS

According to our data, ACS patients with previous CABG history had a higher risk for short- and long-term adverse events.

摘要

目的

进行一项荟萃分析，以研究既往冠状动脉旁路移植术（CABG）对急性冠状动脉综合征（ACS）患者预后的影响。

方法

通过电子参考文献数据库对截至2013年1月的文献进行系统回顾（MEDLINE、Cochrane图书馆、Web of Knowledge、谷歌学术以及其他研究中引用的参考文献）。纳入比较有CABG病史的ACS患者结局与无CABG病史的ACS患者结局的研究。主要关注的终点是死亡率和非致命性急性心肌梗死。使用随机效应荟萃分析模型在三个随访时间点汇总数据。

结果

纳入24项研究，共387181例患者用于分析。有CABG病史的ACS患者年龄更大，糖尿病患者更多，既往心肌梗死病史更常见。有CABG病史的ACS患者住院期间的合并死亡率更高（比值比1.22 [1.04 - 1.44]，p<0.01，I² 88%）。两组的合并调整后比值比无显著差异（调整后比值比1.13 [0.93 - 1.37]，p = 0.22，I² 92%）。有CABG病史的ACS患者30天合并死亡率更高（比值比1.28 [1.05 - 1.55]，p = 0.02，I² 74%）；非调整（比值比1.61 [1.38 - 1.88]，p<0.01，I² 70%）和调整后（调整后比值比1.37 [1.15 - 1.65]，p<0.01，I² 0%）的长期死亡率更高。有CABG病史的ACS患者住院期间和长期再梗死率均更高。