Formica Francesco, Gallingani Alan, Tuttolomondo Domenico, Hernandez-Vaquero Daniel, D'Alessandro Stefano, Singh Gurmeet, Grassa Giulia, Pattuzzi Claudia, Nicolini Francesco
Department of Medicine and Surgery, University of Parma, Parma, Italy.
Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy.
Curr Probl Cardiol. 2024 Jan;49(1 Pt C):102135. doi: 10.1016/j.cpcardiol.2023.102135. Epub 2023 Oct 18.
The benefits of single (SITA) and bilateral internal thoracic arteries (BITA) in diabetics undergoing coronary bypass grafting (CABG) are conflicting. We undertook a study-level meta-analysis to compare early and long-term outcomes of both CABG configurations. PubMed, CENTRAL, and EMBASE were searched for studies comparing BITA versus SITA for isolated CABG surgery in diabetics. Randomized trials or observational studies were considered eligible for the analysis. Kaplan-Meier curves of long-term survival were reconstructed and compared with Cox linear regression; incidence rate ratios (IRR) with 95% confidence intervals (CI) for long-term survival were calculated. Landmark analysis and time-varying hazard ratio (HR) were analyzed. Odds ratios (OR) were extracted for early mortality, postoperative stroke, deep sternal wound infection (DSWI), and myocardial infarction (MI). A random effects meta-analysis was performed. Sensitivity analyses included leave-one-out-analyses and meta-regression. Thirteen studies (7332 patients) were included. Overall, at 20-year follow-up, BITA was associated with higher survival (HR = 0.77; 95% CI, 0.71-0.84; P < 0.0001). Time-varying HR and landmark analysis reported BITA was associated with a higher rate of 10-year survival (HR = 0.75, 95% CI 0.68-0.82, P < 0.0001), while from 10 to 20-year follow-up no difference was revealed (HR = 0.99, 95% CI 0.82-1.19, P = 0.93). There was no increase in early mortality, postoperative MI, stroke, or DSWI between the groups. At meta-regression, the higher the age, the higher the long-term overall survival in patients with BITA. In diabetics, the BITA approach is associated with improved 10-year survival with no increase in early mortality, MI, stroke, or DSWI. In the 10-20-year timeframe, BITA and SITA showed comparable survival.
在接受冠状动脉旁路移植术（CABG）的糖尿病患者中，单支（SITA）和双侧胸廓内动脉（BITA）的益处存在争议。我们进行了一项研究水平的荟萃分析，以比较两种CABG术式的早期和长期结局。检索了PubMed、CENTRAL和EMBASE数据库，查找比较BITA与SITA用于糖尿病患者单纯CABG手术的研究。随机试验或观察性研究被认为符合分析条件。重建长期生存的Kaplan-Meier曲线，并与Cox线性回归进行比较；计算长期生存的发病率比（IRR）及95%置信区间（CI）。分析了地标性分析和时变风险比（HR）。提取早期死亡率、术后卒中、深部胸骨伤口感染（DSWI）和心肌梗死（MI）的比值比（OR）。进行随机效应荟萃分析。敏感性分析包括逐一剔除分析和荟萃回归。纳入了13项研究（7332例患者）。总体而言，在20年随访时，BITA与更高的生存率相关（HR = 0.77；95% CI，0.71 - 0.84；P < 0.0001）。时变HR和地标性分析表明，BITA与10年生存率较高相关（HR = 0.75，95% CI 0.68 - 0.82，P < 0.0001），而在10至20年随访期间未发现差异（HR = 0.99，95% CI 0.82 - 1.19，P = 0.93）。两组之间早期死亡率、术后MI、卒中或DSWI均未增加。在荟萃回归中，年龄越大，BITA患者的长期总体生存率越高。在糖尿病患者中，BITA术式与10年生存率提高相关，且早期死亡率、MI、卒中或DSWI均未增加。在10至20年时间范围内，BITA和SITA的生存率相当。
