Department of Cardiology, University of California Riverside, Riverside, California.
Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
J Cardiovasc Med (Hagerstown). 2021 Apr 1;22(4):285-296. doi: 10.2459/JCM.0000000000001167.
As percutaneous coronary intervention (PCI) technologies have been far improved, we hence conducted an updated systemic review and meta-analysis to determine the comparability between coronary artery bypass graft (CABG) and PCI with drug-eluting stent (DES) in ESRD patients.
We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED and the Cochrane from inception to January 2020. Included studies were published observational studies that compared the risk of cardiovascular outcomes among dialysis patients with CABG and DES. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Subgroup analyses and meta-regression were performed to explore heterogeneity.
Thirteen studies were included in this analysis, involving total 56 422 (CABG 21 740 and PCI 34 682). Compared with DES, our study demonstrated CABG had higher 30-day mortality [odds ratio (OR) 3.85, P = 0.009] but lower cardiac mortality (OR 0.78, P < 0.001), myocardial infarction (OR 0.5, P < 0.001) and repeat revascularization (OR 0.35, P < 0.001). No statistical differences were found between CABG and DES for long-term mortality (OR 0.92, P = 0.055), composite outcomes (OR 0.88, P = 0.112) and stroke (OR 1.49, P = 0.457). Meta-regression suggested diabetes and the presence of left main coronary artery disease as an effect modifier of long-term mortality.
PCI with DES shared similar long-term mortality, composite outcomes and stroke outcomes to CABG among dialysis patients but still was associated with an improved 30-day survival. However, CABG had better rates of myocardial infarction, repeat revascularization and cardiac mortality.
随着经皮冠状动脉介入治疗(PCI)技术的不断进步,我们进行了一项更新的系统评价和荟萃分析,以确定终末期肾病(ESRD)患者中冠状动脉旁路移植术(CABG)与药物洗脱支架(DES)PCI 的可比性。
我们全面检索了 MEDLINE、EMBASE、PUBMED 和 Cochrane 从成立到 2020 年 1 月的数据库。纳入的研究为比较透析患者 CABG 和 DES 心血管结局风险的观察性研究。使用 DerSimonian 和 Laird 的随机效应、通用倒数方差方法对每项研究的数据进行合并,以计算风险比和 95%置信区间。进行亚组分析和荟萃回归以探索异质性。
本分析纳入了 13 项研究,共纳入 56422 例患者(CABG 21740 例,PCI 34682 例)。与 DES 相比,我们的研究表明 CABG 术后 30 天死亡率更高[比值比(OR)3.85,P=0.009],但心脏死亡率较低(OR 0.78,P<0.001)、心肌梗死(OR 0.5,P<0.001)和再次血运重建(OR 0.35,P<0.001)。CABG 与 DES 之间在长期死亡率(OR 0.92,P=0.055)、复合结局(OR 0.88,P=0.112)和卒中(OR 1.49,P=0.457)方面无统计学差异。荟萃回归提示糖尿病和左主干冠状动脉疾病是长期死亡率的效应修饰因子。
在透析患者中,DES PCI 与 CABG 的长期死亡率、复合结局和卒中结局相似,但 30 天生存率仍有所提高。然而,CABG 具有更好的心肌梗死、再次血运重建和心脏死亡率。