Bagheri Faradonbeh Saeed, Ebadi Fard Azar Farbod, Rezapour Aziz, Hajahmadi Marjan, Hajmiresmaili Seyed Javad
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2018 Dec 19;32:127. doi: 10.14196/mjiri.32.127. eCollection 2018.
Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy. Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software. A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy. This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
确定心血管干预措施的有效性在报销决策、医疗保健定价以及为现有临床技术的使用提供临床指导方面发挥着重要作用。本研究旨在回顾和分析与药物治疗相比，血运重建干预措施（冠状动脉旁路移植术和经皮冠状动脉介入治疗）对缺血性心肌病患者的有效性。检索了截至2017年12月的不同数据库。根据纳入和排除标准选择文章。所有研究的质量通过 Jadad 评分和相关清单进行评估。使用I²检验来检验异质性。此外，为了整合相似研究的结果，使用STATA软件进行荟萃分析。总共纳入了18项研究。基于随机效应模型，比较血运重建干预措施与药物治疗有效性的总体结果如下：心脏死亡率为38.94 [95%置信区间：26.95 - 50.94，p<0.001，I² = 99.6%，p<0.001]，生活质量为75.31 [95%置信区间：74.06 - 76.57，p<0.001，I² = 88.8%，p<0.001]，5年生存率为75.76 [95%置信区间：71.99 - 79.53，p<0.001，I² = 99.2%，p<0.001]。此外，在患者满意度指数方面，血运重建干预措施被证明比药物治疗更有效。本研究表明，在所有研究指标中，血运重建干预措施比药物治疗更有效。此外，在血运重建干预措施之间，就生活质量而言，经皮冠状动脉介入治疗在心血管死亡率和5年生存率方面比冠状动脉旁路移植术更有效。而且，冠状动脉旁路移植术比经皮冠状动脉介入治疗更有效。在患者满意度指数方面，纳入的2项研究结果相互矛盾。
