Department of Cardiology, University of Connecticut, Farmington, Connecticut.
Department of Internal Medicine, Saint Agnes Hospital, Baltimore, Maryland.
Coron Artery Dis. 2021 Dec 1;32(8):721-729. doi: 10.1097/MCA.0000000000001030.
There is a persistent controversy regarding the benefit and timing of angiography in patients with stable coronary artery disease (CAD). With this meta-analysis of randomized controlled trials (RCTs) the advantages of initial invasive strategy and medical therapy compared with only medical therapy.
We conducted a literature search of the following databases Pubmed/MEDLINE, Cochrane Library and Embase. Data was collected from all the RCTs that compared early invasive approach with medical therapy alone in treating stable CAD which was conducted by two independent authors. Primary outcomes were all-cause mortality and myocardial infarction (MI), while the secondary outcomes included major adverse cardiovascular events (MACE), cardiovascular mortality, cardiovascular hospitalization, hospitalization due to unstable angina and revascularization events. The Mantel-Haenszel random-effects model was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs).
We included 15 RCTs (13 916 patients, mean age 63.1, 78.9% men). The early invasive strategy, compared with medical therapy alone, did not reveal a significant reduction in the incidence of all-cause mortality (RR, 0.94; 95% CI, 0.84-1.05, P = 0.30) or MI (RR, 0.93; 95% CI, 0.79-1.10, P = 0.42). Furthermore, the early invasive strategy did not reduce the incidence of cardiovascular mortality, cardiovascular hospitalization or the revascularization rate compared with medical therapy alone (P > 0.05). However, the incidence of MACE and hospitalization due to unstable angina were lower in patients treated with early invasive strategy (RR, 0.79; 95% CI, 0.63-0.99, P = 0.04), and (RR, 0.46; 95% CI, 0.32-0.67, P < 0.0001), respectively.
Early invasive strategy with medical therapy did not reduce the incidence of all-cause mortality and MI when compared with medical therapy alone among patients with stable CAD with significant stenosis. However, there was a significant reduction in the incidence of MACE and hospitalization due to unstable angina in the early invasive group.
在稳定性冠心病患者中，血管造影的益处和时机一直存在争议。通过对随机对照试验（RCT）的荟萃分析，比较了初始介入策略与单纯药物治疗的优势。
我们在 Pubmed/MEDLINE、Cochrane 图书馆和 Embase 数据库中进行了文献检索。两名独立作者收集了所有比较早期侵入性方法与单纯药物治疗治疗稳定性 CAD 的 RCT 数据。主要结局为全因死亡率和心肌梗死（MI），次要结局包括主要不良心血管事件（MACE）、心血管死亡率、心血管住院、不稳定型心绞痛住院和血运重建事件。采用 Mantel-Haenszel 随机效应模型估计风险比（RR）和 95%置信区间（CI）。
我们纳入了 15 项 RCT（13916 例患者，平均年龄 63.1 岁，78.9%为男性）。与单纯药物治疗相比，早期介入策略并未显著降低全因死亡率（RR，0.94；95%CI，0.84-1.05，P=0.30）或 MI（RR，0.93；95%CI，0.79-1.10，P=0.42）的发生率。此外，与单纯药物治疗相比，早期介入策略并未降低心血管死亡率、心血管住院率或血运重建率（P>0.05）。然而，早期介入策略治疗组的 MACE 和不稳定型心绞痛住院发生率较低（RR，0.79；95%CI，0.63-0.99，P=0.04），（RR，0.46；95%CI，0.32-0.67，P<0.0001）。
在有严重狭窄的稳定性 CAD 患者中，与单纯药物治疗相比，早期介入策略联合药物治疗并未降低全因死亡率和 MI 的发生率。然而，早期介入组 MACE 和不稳定型心绞痛住院的发生率显著降低。
