Mahmoud Ahmed N, Elgendy Islam Y, Mentias Amgad, Saad Marwan, Ibrahim Walid, Mojadidi Mohammad K, Nairooz Ramez, Eshtehardi Parham, David Anderson R, Samady Habib
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa.
Catheter Cardiovasc Interv. 2017 Oct 1;90(4):541-552. doi: 10.1002/ccd.26970. Epub 2017 Mar 15.
Recent trials comparing PCI with CABG for unprotected left main disease yielded discrepant evidence.
To perform an updated meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease.
Randomized trials comparing PCI versus CABG for patients with unprotected left main coronary artery disease were included. Summary estimates risk ratios (RRs) were performed with a DerSimonian and Laird model at short-term, intermediate and long-term follow-up periods (i.e., 30-days, 1-year, and >1-year). Outcomes evaluated were major adverse cardiac and cerebrovascular events (MACCE), all-cause mortality, myocardial infarction, stroke, revascularization and stent thrombosis or symptomatic graft occlusion.
Six trials with 4,700 patients and a mean SYNTAX score of 23 were included. At short-term follow-up, the risk of MACCE was lower with PCI (RR 0.55, 95% confidence interval [CI] 0.39-0.76) driven by the lower risk of myocardial infarction (RR 0.67, 95% CI 0.46-0.99), and stroke (RR 0.38, 95% CI 0.16-0.90). The risk of MACCE was similar at the intermediate follow-up (RR 1.21, 95% CI 0.97-1.51). At long-term follow-up, PCI was associated with a higher risk of MACCE (RR 1.19, 95% CI 1.01-1.41), due to a higher risk of revascularization (RR 1.62, 95% CI 1.34-1.94), while the risk of all-cause mortality, myocardial infarction, and stroke were similar.
In patients with unprotected left main coronary disease and low to intermediate SYNTAX score, PCI might be an acceptable alternative to CABG. © 2017 Wiley Periodicals, Inc.
近期比较经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗无保护左主干病变的试验得出了不一致的证据。
对比较经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗无保护左主干冠状动脉疾病患者的随机试验进行更新的荟萃分析。
纳入比较PCI与CABG治疗无保护左主干冠状动脉疾病患者的随机试验。在短期、中期和长期随访期（即30天、1年和>1年）使用DerSimonian和Laird模型进行汇总估计风险比（RR）。评估的结局包括主要不良心脑血管事件（MACCE）、全因死亡率、心肌梗死、中风、血运重建以及支架血栓形成或有症状的移植血管闭塞。
纳入了6项试验，共4700例患者，平均SYNTAX评分为23。在短期随访中，PCI组MACCE风险较低（RR 0.55，95%置信区间[CI] 0.39 - 0.76），这是由于心肌梗死风险较低（RR 0.67，95% CI 0.46 - 0.99）以及中风风险较低（RR 0.38，95% CI 0.16 - 0.90）。在中期随访时，MACCE风险相似（RR 1.21，95% CI 0.97 - 1.51）。在长期随访中，PCI与较高的MACCE风险相关（RR 1.19，95% CI 1.01 - 1.41），这是由于血运重建风险较高（RR 1.62，95% CI 1.34 - 1.94），而全因死亡率、心肌梗死和中风风险相似。
在无保护左主干冠状动脉疾病且SYNTAX评分低至中等的患者中，PCI可能是CABG的可接受替代方案。© 2017威利期刊公司
