经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗多支或左主干冠状动脉疾病后的十年结果：系统回顾和荟萃分析,Journal of Cardiothoracic Surgery

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经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗多支或左主干冠状动脉疾病后的十年结果：系统回顾和荟萃分析
Journal of Cardiothoracic Surgery ( IF 1.6 ) Pub Date : 2023-02-02 , DOI: 10.1186/s13019-023-02101-y
Shitao Feng ₁ , Mingli Li ₁ , Jiayue Fei ₁ , Anqin Dong ₁ , Wenli Zhang ₁ , Yanhua Fu ₁ , Yang Zhao ₁

Affiliation

经皮冠状动脉介入治疗 (PCI) 和冠状动脉旁路移植术 (CABG) 治疗多支冠状动脉 (MVCA) 或左主干冠状动脉 (LMCA) 疾病后的短期和长期比较结果备受争议。我们进行了一项荟萃分析，以评估 PCI 和 CABG 在长期随访中治疗 MVCA 或 LMCA 患者的差异。检索了 2000 年 1 月 1 日至 2021 年 1 月 1 日期间在 PubMed、EMBASE 和 The Cochrane Library 中的文献，包括 RCT 和观察性研究 (OS)。主要结果是 10 年随访时的全因死亡率，次要结果包括心脏死亡率、重复血运重建、心肌梗死和卒中。共有 5 个随机对照试验报告了来自 3013 名参与者的数据和 4 个操作系统的 5608 名参与者被纳入分析。PCI 和 CABG 在全因死亡率方面无显着差异（优势比 (OR) 1.03 [95% 置信区间 (CI) 0.89 至 1.19]），而 PCI 与较高的心脏死亡率相关（OR 0.76 [95% CI] 0.65 至 0.90]）和重复血运重建率与 CABG 相比（OR 1.77 [95% CI 1.08 至 2.89]；I2 = 94.61%）。PCI 和 CABG 在 RCT 或 OS 中重复血运重建以及 RCT 或 OS 中心肌梗死方面的差异不显着。在 OS 中，PCI 组的卒中发生率低于 CABG，但在 RCT 中并非如此。与 PCI 相比，CABG 中的卒中发生率显着增加（OR 0.65 [95% CI 0.53 至 0.80]；I2 = 0.00%）。未观察到 PCI 和 CABG 在心肌梗死方面的显着差异（OR 0.92 [95% CI 0.64 至 1.31]；I2 = 57.84%）。来自我们研究和之前研究的证据表明，在改善 MVCA 患者的 5 年而非 10 年生存率方面，CABG 优于 PCI。相比之下，CABG 和 PCI 治疗 LMCA 患者的 5 年或 10 年生存率没有显着差异。需要更多的长期试验来更好地定义两种技术之间的结果差异。

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Ten-year outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel or left main coronary artery disease: a systematic review and meta-analysis

Short-term and long-term comparative outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for multivessel coronary artery (MVCA) or left main coronary artery (LMCA) disease are highly debated. We performed a meta-analysis to evaluate the difference between PCI and CABG for the treatment of patients with MVCA or LMCA in long-term follow-up. Literatures were searched in PubMed, EMBASE and The Cochrane Library from January 1, 2000 to January 1, 2021, including RCTs and observational studies (OSs). The primary outcome was all-cause mortality at 10 years follow-up, and the secondary outcomes included cardiac mortality, repeated revascularization, myocardial infarction, and stroke. A total of 5 RCTs reporting data from 3013 participants and 4 OSs of 5608 participants were included for analysis. There was no significant difference between PCI and CABG in all-cause mortality (Odds Ratio (OR) 1.03 [95% confidence interval (CI) 0.89 to 1.19]), whereas PCI was associated with higher cardiac mortality (OR 0.76 [95% CI 0.65 to 0.90]) and repeated revascularization rate comparing to CABG (OR 1.77 [95% CI 1.08 to 2.89]; I2 = 94.61%). The difference between PCI and CABG in repeated revascularization in either RCTs or OSs, in myocardial infarction in either RCTs or OSs were not significant. In OSs, stroke rate in PCI group was lower than those in CABG, but not in RCTs. There was a significant increase of stroke rate in CABG comparing to PCI (OR 0.65 [95% CI 0.53 to 0.80]; I2 = 0.00%). No significant difference between PCI and CABG in myocardial infarction was not observed (OR 0.92 [95% CI 0.64 to 1.31]; I2 = 57.84%). Evidence from our study and prior studies suggested the superiority of CABG over PCI in improving 5- but not 10-year survival among patients with MVCA. In the contrast, there was no significant difference between CABG and PCI for treating patients with LMCA in either 5- or 10-year survival rate. More long-term trials are needed to better define differences of outcome between 2 techniques.

更新日期：2023-02-03

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