Kinnaird Tim, Kwok Chun Shing, Narain Aditya, Butler Rob, Ossei-Gerning Nicholas, Ludman Peter, Moat Neil, Anderson Richard, Mamas Mamas A
Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
Am J Cardiol. 2016 Oct 15;118(8):1171-1177. doi: 10.1016/j.amjcard.2016.07.030. Epub 2016 Jul 29.
We performed a meta-analysis of the studies comparing the efficacy and safety of coronary artery bypass surgery against percutaneous coronary intervention with drug-eluting stents (PCI-DES) in patients with isolated LAD disease. Because of the limited randomized trial data, the optimal revascularization strategy for patients with isolated LAD disease remains uncertain. Using MEDLINE and EMBASE to source data, 11 studies (3 randomized trials and 8 cohort studies) including 5,044 participants were identified. No significant difference in mortality between PCI-DES and coronary artery bypass surgery (CABG; 111 of 2,122 [5.2%] and 120 of 2,574 [4.7%]; relative risk [RR] 1.23; 95% confidence interval [CI] 0.90 to 1.69) was detected. For MACE, PCI-DES was associated with significant increase in adverse events (RR 1.41; 95% CI 1.03 to 1.93, 8 studies, 4,230 participants). There were no significant differences in the risk of myocardial infarction (RR 0.86; 95% CI 0.58 to 1.26) or stroke (RR 2.36; 95% CI 0.54 to 10.43) between the 2 groups. There were 239 target vessel revascularization (TVR) events among 2,237 participants in the PCI-DES group (10.7%) and 145 TVR events among 2,793 participants in the CABG group (5.2%) with a significant increased risk of TVR in the PCI group (RR 2.52; 95% CI 1.69 to 3.77, 5,030 participants) compared with CABG. In conclusion, for patients with isolated disease of the LAD, meta-analysis of the available data suggests revascularization with a PCI-DES strategy offers similar mortality, MI, and stroke rates to CABG at the expense of increased TVR. Much of the data are derived from registries using first-generation DES, and further randomized trials with more contemporary platforms are needed.
我们对比较冠状动脉搭桥手术与药物洗脱支架经皮冠状动脉介入治疗(PCI-DES)在单纯左前降支病变患者中的疗效和安全性的研究进行了荟萃分析。由于随机试验数据有限,单纯左前降支病变患者的最佳血运重建策略仍不确定。利用MEDLINE和EMBASE检索数据,共纳入11项研究(3项随机试验和8项队列研究),包括5044名参与者。未检测到PCI-DES与冠状动脉搭桥手术(CABG)在死亡率上存在显著差异(2122例中有111例[5.2%],2574例中有120例[4.7%];相对风险[RR]1.23;95%置信区间[CI]0.90至1.69)。对于主要不良心血管事件(MACE),PCI-DES与不良事件显著增加相关(RR 1.41;95%CI 1.03至1.93,8项研究,4230名参与者)。两组在心肌梗死风险(RR 0.86;95%CI 0.58至1.26)或中风风险(RR 2.36;95%CI 0.54至10.43)方面无显著差异。PCI-DES组2237名参与者中有239例发生靶血管血运重建(TVR)事件(10.7%),CABG组2793名参与者中有145例发生TVR事件(5.2%),与CABG相比,PCI组TVR风险显著增加(RR 2.52;95%CI 1.69至3.77,5030名参与者)。总之,对于单纯左前降支病变患者,对现有数据的荟萃分析表明,采用PCI-DES策略进行血运重建与CABG的死亡率、心肌梗死和中风发生率相似,但代价是TVR增加。大部分数据来自使用第一代DES的注册研究,需要更多采用当代平台的进一步随机试验。