冠状动脉计算机断层扫描血管造影术与有创冠状动脉造影术对稳定型冠状动脉疾病预后的比较：一项系统评价和荟萃分析。
Comparison of prognosis between coronary computed tomography angiography versus invasive coronary angiography for stable coronary artery disease: a systematic review and meta-analysis.
作者信息
Xie Qingya, Zhou Lingling, Li Ying, Zhang Ruizhe, Wei Han, Ma Gaoxiang, Tang Yuping, Xiao Pingxi
机构信息
Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.
Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
出版信息
Front Cardiovasc Med. 2023 May 5;10:1010536. doi: 10.3389/fcvm.2023.1010536. eCollection 2023.
BACKGROUND
The impact of using invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) as an initial examination on the incidence of major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease and the occurrence of major operation-related complications is uncertain.
OBJECTIVE
This study aimed to explore the effects of ICA vs. CCTA on MACEs, all-cause death, and major operation-related complications.
METHODS
A systematic search of electronic databases (PubMed and Embase) was conducted for randomized controlled trials and observational studies comparing MACEs between ICA and CCTA from January 2012 to May 2022. The primary outcome measure was analyzed using a random-effects model as a pooled odds ratio (OR). The main observations were MACEs, all-cause death, and major operation-related complications.
RESULTS
A total of six studies, comprising 26,548 patients, met the inclusion criteria (ICA = 8,472; CCTA = 18,076). There were statistically significant differences between ICA and CCTA for MACE [OR 1.37; 95% confidence interval (CI), 1.06-1.77; = 0.02], all-cause death (OR 1.56; 95% CI, 1.38-1.78; < 0.00001), and major operation-related complications (OR 2.10; 95% CI, 1.23-3.61; = 0.007) among patients with stable coronary artery disease. Subgroup analysis demonstrated statistically significant results in the impact of ICA or CCTA on MACEs according to the length of follow-up. Compared to CCTA, ICA was related to a higher incidence of MACEs in the subgroup with a short follow-up (≤3 years) (OR 1.74; 95% CI, 1.54-1.96; < 0.00001).
CONCLUSIONS
Among patients with stable coronary artery disease, an initial examination with ICA was significantly associated with the risk of MACEs, all-cause death, and major procedure-related complications compared to CCTA in this meta-analysis.
背景
对于稳定型冠状动脉疾病患者，将有创冠状动脉造影（ICA）或冠状动脉计算机断层扫描血管造影（CCTA）作为初始检查对主要不良心血管事件（MACE）发生率及主要手术相关并发症发生情况的影响尚不确定。
目的
本研究旨在探讨ICA与CCTA对MACE、全因死亡及主要手术相关并发症的影响。
方法
对电子数据库（PubMed和Embase）进行系统检索，以查找2012年1月至2022年5月间比较ICA和CCTA之间MACE的随机对照试验和观察性研究。主要结局指标采用随机效应模型分析，作为合并比值比（OR）。主要观察指标为MACE、全因死亡及主要手术相关并发症。
结果
共有6项研究，包含26548例患者，符合纳入标准（ICA组=8472例；CCTA组=18076例）。在稳定型冠状动脉疾病患者中，ICA和CCTA在MACE方面[OR 1.37；95%置信区间（CI），1.06 - 1.77；P = 0.02]、全因死亡方面（OR 1.56；95% CI，1.38 - 1.78；P < 0.00001）及主要手术相关并发症方面（OR 2.10；95% CI，1.23 - 3.61；P = 0.007）存在统计学显著差异。亚组分析显示，根据随访时间长短，ICA或CCTA对MACE的影响存在统计学显著结果。与CCTA相比，在随访时间短（≤3年）的亚组中，ICA与更高的MACE发生率相关（OR 1.74；95% CI，1.54 - 1.96；P < 0.00001）。
结论
在此荟萃分析中，对于稳定型冠状动脉疾病患者，与CCTA相比，采用ICA进行初始检查与MACE风险、全因死亡及主要手术相关并发症显著相关。
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