Takagi Hisato, Ando Tomo, Umemoto Takuya
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
Catheter Cardiovasc Interv. 2018 Mar 1;91(4):697-709. doi: 10.1002/ccd.27235. Epub 2017 Aug 11.
To compare follow-up outcomes after percutaneous coronary intervention with drug-eluting stents (DES-PCI) versus coronary artery bypass grafting (CABG) for left-main coronary artery disease (LMCAD), we performed a meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity-score analysis.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through November 2016. Eligible studies were RCTs or observational studies with propensity-score analysis of DES-PCI versus CABG enrolling patients with LMCAD and reporting ≥ 6-month mortality, myocardial infarction (MI), stroke, or repeat revascularization (RRV). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios (HRs) in the random-effects model.
We identified 5 RCTs and 17 observational studies with propensity-score analysis enrolling a total of 12,387 patients. Pooled analysis demonstrated a significant increase in a composite of death, MI, and RRV (with/without stroke) after DES-PCI (HR, 1.42; P < 0.00001); no significant difference in a composite of death and MI (with/without stroke); no significant differences in mortality and stroke; a strong trend toward an increase in MI after DES-PCI (HR, 1.44; P = 0.05); and significant increases in any (HR, 1.86; P < 0.00001), target-vessel (HR, 3.28; P < 0.00001), and target-lesion RRV (HR, 2.26; P = 0.003) after DES-PCI.
When compared with CABG, DES-PCI for LMCAD was associated with increases in RRV and the composite of death, MI, and RRV (with/without stroke), despite no differences in mortality, MI, stroke, and the composite of death and MI (with/without stroke).
为比较药物洗脱支架经皮冠状动脉介入治疗（DES-PCI）与冠状动脉旁路移植术（CABG）治疗左主干冠状动脉疾病（LMCAD）后的随访结果，我们进行了一项随机对照试验（RCT）和倾向评分分析观察性研究的荟萃分析。
检索截至2016年11月的MEDLINE、EMBASE和Cochrane对照试验中央注册库。符合条件的研究为RCT或观察性研究，采用倾向评分分析比较DES-PCI与CABG治疗LMCAD患者，并报告≥6个月的死亡率、心肌梗死（MI）、中风或再次血运重建（RRV）。在随机效应模型中，使用对数风险比（HR）的逆方差加权平均值合并各研究的估计值。
我们确定了5项RCT和17项采用倾向评分分析的观察性研究，共纳入12387例患者。汇总分析显示，DES-PCI后死亡、MI和RRV（伴或不伴中风）的复合终点显著增加（HR，1.42；P＜0.00001）；死亡和MI（伴或不伴中风）的复合终点无显著差异；死亡率和中风无显著差异；DES-PCI后MI有增加的强烈趋势（HR，1.44；P = 0.05）；DES-PCI后任何RRV（HR，1.86；P＜0.00001）、靶血管RRV（HR，3.28；P＜0.00001）和靶病变RRV（HR，2.26；P = 0.003）均显著增加。
与CABG相比，LMCAD患者接受DES-PCI后RRV以及死亡、MI和RRV（伴或不伴中风）的复合终点增加，尽管死亡率、MI、中风以及死亡和MI（伴或不伴中风）的复合终点无差异。
