与单纯冠状动脉旁路移植术相比，冠状动脉内膜切除术联合冠状动脉旁路移植术会降低移植血管通畅率：一项荟萃分析。
Coronary endarterectomy with coronary artery bypass graft decreases graft patency compared with isolated coronary artery bypass graft: a meta-analysis.
作者信息
Song Yangwu, Xu Fei, Du Junzhe, Zhang Jiqiang, Feng Wei
机构信息
Department of Cardiac Surgery, Fuwai Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Interact Cardiovasc Thorac Surg. 2017 Jul 1;25(1):30-36. doi: 10.1093/icvts/ivx045.
OBJECTIVES
This meta-analysis aims to assess the graft patency quantitatively and statistically.
METHODS
Eleven observational studies were identified by systematic literature search, incorporating 3311 patients undergoing coronary endarterectomy (CE) + coronary artery bypass graft (CABG) and 3990 undergoing isolated CABG, which were analysed using random-effects modelling. Heterogeneity, quality of scoring and risk of bias were assessed and reangiographic outcomes were documented.
RESULTS
Adjunctive CE decreased graft patency [odds ratios = 0.43, 95% confidence interval [0.29-0.63], z = 4.33, P < 0.0001] with moderate heterogeneity, while the baseline demographics differed considerably.
CONCLUSIONS
Whether CE remains a viable option to CABG requires novel studies collecting corresponding data from bench to bedside. To achieve satisfactory efficacy, surgeons should carefully weigh possible benefits and adverse effects of CE and prepare the surgical strategy adequately.
目的
本荟萃分析旨在对移植血管通畅情况进行定量和统计学评估。
方法
通过系统文献检索确定了11项观察性研究，纳入3311例行冠状动脉内膜切除术（CE）+冠状动脉旁路移植术（CABG）的患者以及3990例行单纯CABG的患者，采用随机效应模型进行分析。评估了异质性、评分质量和偏倚风险，并记录了再次血管造影结果。
结果
辅助性CE降低了移植血管通畅率[比值比=0.43，95%置信区间[0.29 - 0.63]，z = 4.33，P < 0.0001]，异质性中等，而基线人口统计学差异较大。
结论
CE是否仍是CABG的可行选择需要开展新的研究，收集从实验台到临床的相应数据。为获得满意疗效，外科医生应仔细权衡CE的潜在益处和不良反应，并充分准备手术策略。
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