目的:我们的目的是通过系统评价荟萃分析评估冠状动脉旁路移植术(CABG)患者中心肌生存力的存在是否是死亡率的预测因素。
方法:根据PRISMA指南对EMBASE和PubMed进行全面审查,包括对接受CABG的患者进行的研究,评估心肌生存力并记录长期死亡率,年龄和性别研究仅限于过去十年,和数据通过成像模式(磁共振成像[MRI]或核医学)进行分层。用于评估集合效应的随机效应模型,使用卡方和I2统计量进行异质性评估,通过漏斗图和Egger检验评估发表偏倚。
结果:当代数据的荟萃分析(2010年1月至2020年10月)产生了3,621份手稿,其中92份是相关的,6适合纳入993例患者。汇总分析显示,与有存活心肌的患者相比,无存活心肌的患者接受CABG的死亡风险为1.34倍(95%CI1.01-1.79,p=0.05)。MRI或核医学模式的亚组分析没有统计学意义,并且在meta回归中没有年龄或性别的混淆。成像模式和诊断标准存在显著异质性,但研究结果之间的异质性较低,I2统计值为29%。发表偏倚的风险在纽卡斯尔-渥太华量表上是中等的),但无统计学意义(Egger检验系数=1.3,95CI-0.35-2.61,p=0.10)。
结论:冠状动脉血运重建手术有多种评估心脏生存力的方法,进行荟萃分析充满局限性。我们的荟萃分析表明,无法存活的心肌的发现不能用于冠状动脉手术中的风险评估。
OBJECTIVE: Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG) through a systematic
review meta-analysis.
METHODS: Comprehensive
review of EMBASE and PubMed in accordance with PRISMA guidelines, including studies of patients undergoing CABG with assessment of myocardial viability and recorded long-term mortality, age and sex. Studies were restricted to the last decade, and data were stratified by imaging modality (magnetic resonance imaging [MRI] or nuclear medicine). Random-effects model for assessing pooled effect, heterogeneity assessment using Chi-square and I2 statistics, publication bias assessed by funnel plots and Egger\'s test.
RESULTS: Meta-analysis of contemporary data (January 2010 to October 2020) yielded 3,621 manuscripts of which 92 were relevant, and 6 appropriate for inclusion with 993 patients. Pooled analysis showed that patients with non-viable myocardium undergoing CABG are at 1.34 times the risk of mortality compared to those with viable myocardium (95% CI 1.01-1.79, p=0.05). Subgroup analysis of the MRI or nuclear medicine modalities was not statistically significant and there was no confounding by age or sex in meta-regression. There was significant heterogeneity in imaging modality and diagnostic criteria, but heterogeneity between study findings was low with an I2 statistic of 29%. The risk of publication bias was moderate on the Newcastle-Ottawa Scale), but not statistically significant (Egger\'s Test coefficient=1.3, 95%CI -0.35-2.61, p=0.10).
CONCLUSIONS: There is a multitude of methods for assessing cardiac viability for coronary revascularisation surgery, making meta-analyses fraught with limitations. Our meta-analysis demonstrates that the finding of non-viable myocardium can not be used draw conclusions for risk assessment in coronary surgery.