微创直接冠状动脉旁路移植术与药物洗脱支架治疗孤立性左前降支病变的比较：对7710例患者的系统评价和荟萃分析
Comparison of minimally invasive direct coronary artery bypass and drug-eluting stents for management of isolated left anterior descending artery disease: a systematic review and meta-analysis of 7,710 patients.
作者信息
Raja Shahzad G, Uzzaman Mohsin, Garg Sheena, Santhirakumaran Gowthanan, Lee Michelle, Soni Manish K, Khan Habib
机构信息
Department of Cardiac Surgery, Harefield Hospital, London, UK.
Department of Cardiac Surgery, Queen Elizabeth Hospital, Birmingham, UK.
出版信息
Ann Cardiothorac Surg. 2018 Sep;7(5):567-576. doi: 10.21037/acs.2018.06.16.
BACKGROUND
In the contemporary era of drug-eluting stents (DES) the issue of optimal revascularization strategy for patients with isolated disease of the left anterior descending (LAD) artery has gained more significance. We aimed to evaluate the current best evidence on the subject by performing a systematic review and meta-analysis of the studies comparing minimally invasive direct coronary artery bypass (MIDCAB) grafting with DES in patients with isolated LAD disease.
METHODS
A literature search was conducted from 1966 through March 2018 using MEDLINE, EMBASE, and other scientific databases to identify relevant articles. Analyzed outcomes included all-cause mortality, myocardial infarction (MI), major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR). The random effects model was used to calculate the outcomes of both binary and continuous data to control any heterogeneity between the studies. Heterogeneity amongst the trials was determined by means of the Cochran Q value and quantified using the I inconsistency test. All P values were 2-sided and a 5% level was considered significant.
RESULTS
A total of 7,710 patients from 12 studies were identified. There was no significant difference in mortality rate [pooled odds ratio (OR) =0.92; 95% confidence interval (CI), 0.65 to 1.32; P=0.66], MI rate (pooled OR =1.13, 95% CI, 0.62 to 2.06; P=0.69) or MACCE (pooled OR =1.31; 95% CI, 0.58 to 2.95; P=0.52). However, TVR rate was significantly more for patients having percutaneous intervention with DES (pooled OR =0.27; 95% CI, 0.16 to 0.45; P<0.0001) compared to MIDCAB.
CONCLUSIONS
MIDCAB offers superior freedom from TVR with similar mortality, MI rate, and MACCE compared to percutaneous intervention with DES for revascularization in patient with isolated proximal LAD stenosis.
背景
在当代药物洗脱支架（DES）时代，对于单纯左前降支（LAD）动脉疾病患者，最佳血运重建策略问题变得更加重要。我们旨在通过对比较微创直接冠状动脉旁路移植术（MIDCAB）与DES治疗单纯LAD疾病患者的研究进行系统评价和荟萃分析，来评估该主题的当前最佳证据。
方法
使用MEDLINE、EMBASE和其他科学数据库，从1966年至2018年3月进行文献检索，以识别相关文章。分析的结局包括全因死亡率、心肌梗死（MI）、主要不良心脑血管事件（MACCE）和靶血管血运重建（TVR）。采用随机效应模型计算二分类和连续数据的结局，以控制研究之间的任何异质性。试验之间的异质性通过Cochran Q值确定，并使用I²不一致性检验进行量化。所有P值均为双侧，5%的水平被认为具有统计学意义。
结果
共纳入12项研究中的7710例患者。死亡率[合并比值比（OR）=0.92；95%置信区间（CI），0.65至1.32；P=0.66]、MI发生率（合并OR =1.13，95%CI，0.62至2.06；P=0.69）或MACCE（合并OR =1.31；95%CI，0.58至2.95；P=0.52）无显著差异。然而，与MIDCAB相比，接受DES经皮介入治疗的患者TVR发生率显著更高（合并OR =0.27；95%CI, 0.16至0.45；P<0.0001）。
结论
对于单纯近端LAD狭窄患者的血运重建，与DES经皮介入治疗相比，MIDCAB在TVR方面具有更好的效果且死亡率、MI发生率和MACCE相似。
Zotero 插件