Urso Stefano, Sadaba Rafael, González Jesús María, Nogales Eliú, Pettinari Matteo, Tena María Ángeles, Paredes Federico, Portela Francisco
Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Cardiac Surgery Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
J Card Surg. 2019 Sep;34(9):837-845. doi: 10.1111/jocs.14169. Epub 2019 Aug 2.
We explored the current evidence available on total arterial revascularization (TAR) carrying out a meta-analysis of propensity score-matched studies comparing TAR versus non-TAR strategy.
PubMed, EMBASE, and Google Scholar were searched for propensity score-matched studies comparing TAR vs non-TAR. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The Der-Simonian and Laird method were used to compute the combined risk ratio (RR) of 30-day mortality, deep sternal wound infection, and reoperation for bleeding.
Eighteen TAR vs non-TAR matched populations were included. Meta-analysis showed a significant benefit in terms of long-term survival of the TAR group over the non-TAR group (HR: 0.73; 95% confidence interval [CI]: 0.68-0.78). Better long-term survival over non-TAR strategy was confirmed by both subgroups: TAR with the bilateral internal mammary artery (BIMA) and TAR without BIMA. Meta-regression suggests that TAR may offer a higher protective survival effect in diabetic patients (coefficient: -0.0063; 95% CI: -0.01 to 0.0006), when carried out with BIMA (coefficient: -0.15; 95% CI: -0.27 to -0.03) or using three arterial conduits (coefficient: -0.12; 95% CI: -0.25 to 0.007). A TAR strategy carried out using BIMA, differently from TAR without BIMA, increases the risk of deep sternal infection (RR: 1.44; 95% CI: 1.17-1.77).
TAR provides a long-term survival benefit compared with the non-TAR strategy. Also, compared with TAR without BIMA, TAR with BIMA may offer a higher protective long-term survival effect at the expense of a higher risk of sternal deep wound infection.
我们通过对倾向评分匹配研究进行荟萃分析，比较全动脉血运重建（TAR）与非TAR策略，探索目前有关TAR的现有证据。
在PubMed、EMBASE和谷歌学术中检索比较TAR与非TAR的倾向评分匹配研究。采用通用逆方差法计算长期死亡率的合并风险比（HR）。采用Der-Simonian和Laird法计算30天死亡率、深部胸骨伤口感染和出血再次手术的合并风险比（RR）。
纳入了18个TAR与非TAR匹配人群。荟萃分析显示，TAR组在长期生存方面比非TAR组有显著益处（HR：0.73；95%置信区间[CI]：0.68-0.78）。两个亚组均证实，与非TAR策略相比，长期生存率更高：采用双侧乳内动脉（BIMA）的TAR和不采用BIMA的TAR。荟萃回归表明，当采用BIMA（系数：-0.15；95%CI：-0.27至-0.03）或使用三根动脉导管（系数：-0.12；95%CI：-0.25至0.007）时，TAR在糖尿病患者中可能提供更高的生存保护作用（系数：-0.0063；95%CI：-0.01至0.0006）。与不采用BIMA的TAR不同，采用BIMA进行的TAR策略会增加深部胸骨感染的风险（RR：1.44；95%CI：1.17-1.77）。
与非TAR策略相比，TAR具有长期生存益处。此外，与不采用BIMA的TAR相比，采用BIMA的TAR可能提供更高的长期生存保护作用，但代价是胸骨深部伤口感染风险更高。
