Afrouzi Mohammad, Azar Farbod Ebadi Fard, Aboutorabi Ali, Hajahmadi Marjan, Ebadi Seyed Javad
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
Egypt Heart J. 2021 Nov 4;73(1):99. doi: 10.1186/s43044-021-00225-x.
To estimate death probabilities after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and medical therapy (MT) in patients under 60 years old. We conducted a search systematic on PubMed, Embase, Cochrane Library, and Web of Science up to January 2021. The study included three parts. In the probabilities part (A), Comprehensive Meta-Analysis, and in the comparison parts (B and C), Review Manager was used in conducting meta-analyses. Nine studies consisting of 16,410 people with a mean age of 51.2 ± 6 years were included in the meta-analysis. Over a mean follow-up of 3.7 ± 2 years, overall mortality after CABG, PCI and MT was 3.6% (95% CI 0.021-0.061), 4.3% (95% CI 0.023-0.080) and 9.7% (95% CI 0.036-0.235), respectively. The length of follow-up periods was almost the same and did not differ much (p = 0.19). In Part B (without adjustment of baseline characteristics), 495 (4.0%) of 12,198 patients assigned to CABG died compared with 748 (4.5%) of 16,458 patients assigned to PCI (risk ratio [RR]: 0.77, 95% CI 0.50-1.20; p = 0.25). Seventy-four (3.5%) of 2120 patients assigned to CABG and 68 (4.2%) of 1621 patients assigned to PCI died compared with 103 (9.5%) of 1093 patients assigned to MT in equal follow-up periods (CABG-MT: RR 0.34; 95% CI 0.23-0.51; p < 0.002) (PCI-MT: RR 0.40; 95% CI 0.30-0.53; p = 0.02). In Part C, overall mortality after PCI in PACD patients with STEMI was higher in elderly versus young (RR 2.64; 95% CI 2.11-3.30) and is lower in men versus women (RR 0.61; 95% CI 0.44-0.83). Mortality probabilities obtained are one of the most important factors of effectiveness in the economic evaluation studies; these rates can be used to determine the cost-effectiveness of procedures in CAD patients aged < 60 years.
为了评估60岁以下患者接受冠状动脉旁路移植术（CABG）、经皮冠状动脉介入治疗（PCI）和药物治疗（MT）后的死亡概率。我们截至2021年1月在PubMed、Embase、Cochrane图书馆和科学网进行了系统检索。该研究包括三个部分。在概率部分（A），使用综合荟萃分析，在比较部分（B和C），使用Review Manager进行荟萃分析。荟萃分析纳入了9项研究，共16410人，平均年龄为51.2±6岁。在平均3.7±2年的随访期内，CABG、PCI和MT后的总体死亡率分别为3.6%（95%CI 0.021 - 0.061）、4.3%（95%CI 0.023 - 0.080）和9.7%（95%CI 0.036 - 0.235）。随访期长度几乎相同，差异不大（p = 0.19）。在B部分（未调整基线特征），分配接受CABG的12198例患者中有495例（4.0%）死亡，而分配接受PCI的16458例患者中有748例（4.5%）死亡（风险比[RR]：0.77，95%CI 0.50 - 1.20；p = 0.25）。在相等的随访期内，分配接受CABG的2120例患者中有74例（3.5%）死亡，分配接受PCI的1621例患者中有68例（4.2%）死亡，而分配接受MT的1093例患者中有103例（9.5%）死亡（CABG - MT：RR 0.34；95%CI 0.23 - 0.51；p < 0.002）（PCI - MT：RR 0.40；95%CI 0.30 - 0.53；p = 0.02）。在C部分，老年ST段抬高型心肌梗死（STEMI）的PACD患者接受PCI后的总体死亡率高于年轻患者（RR 2.64；95%CI 2.11 - 3.30），男性低于女性（RR 0.61；95%CI 0.44 - 0.83）。获得的死亡概率是经济评估研究中有效性的最重要因素之一；这些比率可用于确定60岁以下CAD患者手术的成本效益。
