Pérez-Camargo Daniel, Campelos-Fernández Paula, Travieso Alejandro, Montero-Cruces Lourdes, Carnero-Alcázar Manuel, Olmos-Blanco Carmen, Cobiella-Carnicer Javier, Álvarez-Arcaya Arantzazu, Reguillo-Lacruz Fernando, Maroto-Castellanos Luis C
Cardiac Surgery Department, Hospital Universitario Clínico San Carlos, Calle Martin Lagos S/N, Madrid, 28040, Spain.
The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
J Cardiothorac Surg. 2024 Dec 20;19(1):666. doi: 10.1186/s13019-024-03167-y.
Despite the advances in the last decades for treatment of ischemic heart disease, women continue to experience poorer prognosis than men and currently, there is a gap in knowledge regarding the optimal revascularization strategy in women.
Compare the long-term outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for the treatment of stable ischemic heart disease in women.
A systematic search was conducted including randomized clinical trials (RCTs) comparing PCI with drug-eluting stents with CABG. The primary outcome were the composite outcomes of death, stroke or myocardial infarction (MI) and death, stroke, MI or repeat revascularization. Secondary outcomes included the individual components of the primary outcomes. Pooled hazard ratios with 95% confidence intervals were calculated in a fixed- effects meta-analysis using the inverse of variance method. Risk of bias and sensitivity analyses were also conducted.
Six multicenter, RCTs were included after eligibility assessment. Median follow-up was 6.25 years (IQR: 5- 2.5). A significant benefit for CABG over PCI was observed for the primary composite outcomes of death, stroke, MI (HR = 1.24; 95% CI 1.01-1.52; p = 0.037) and death, stroke, MI or repeat revascularization (HR = 1.60; 95% CI 1.25-2.03; p < 0.000).
In the present study-level metanalysis, CABG is associated with a lower risk of major adverse cardiovascular events than PCI at long term follow-up in women.
尽管在过去几十年中缺血性心脏病的治疗取得了进展，但女性的预后仍比男性差，目前，关于女性最佳血运重建策略的知识存在差距。
比较经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）治疗女性稳定型缺血性心脏病的长期疗效。
进行了一项系统检索，包括比较PCI与药物洗脱支架与CABG的随机临床试验（RCT）。主要结局是死亡、中风或心肌梗死（MI）以及死亡、中风、MI或再次血运重建的复合结局。次要结局包括主要结局的各个组成部分。使用方差倒数法在固定效应荟萃分析中计算合并风险比及95%置信区间。还进行了偏倚风险和敏感性分析。
经过资格评估后纳入了6项多中心RCT。中位随访时间为6.25年（四分位间距：5 - 2.5）。对于死亡、中风、MI的主要复合结局（HR = 1.24；95% CI 1.01 - 1.52；p = 0.037）以及死亡、中风、MI或再次血运重建（HR = 1.60；95% CI 1.25 - 2.03；p < 0.000），观察到CABG比PCI有显著益处。
在本研究水平的荟萃分析中，在女性长期随访中，CABG与主要不良心血管事件风险低于PCI相关。
