背景:关于泵外CABG和泵上CABG的争论已经持续了三十多年。尽管已经报道了许多随机对照试验(RCT)和荟萃分析,新的证据出现了。因此,更新和全面的荟萃分析以指导临床实践至关重要.
方法:全面搜索2000年以后发表的符合条件的文章,报告涉及至少100名患者的RCT,并比较非体外循环CABG和体外循环CABG,在包括Embase在内的整个数据库中执行,OvidMedline和WebofScience。主要关注的结果包括中风的短期发病率和长期死亡率。主要分析使用固定效应模型和逆方差方法。建议评估等级,发展,并采用评定(GRADE)对证据的确定性进行评定。
结果:经过彻底筛查,包括39篇文章,由28个RCT组成,共涉及16090名患者。非体外循环CABG显着降低了短期中风的发生率(1.27%vs.1.78%,OR:0.74,P=0.03,确定性高)。然而,观察到它与增加的中期冠状动脉再介入(2.77%vs.1.85%,RR:1.49,P<0.01,高确定性)和长期死亡率(21.8%vs.21.0%,RR:1.09,P=0.02,中等确定性)。
结论:非体外循环CABG可显著降低中风的短期发生率,但也会增加中期冠脉再介入的发生率。此外,它可能会增加长期死亡率。
BACKGROUND: The ongoing debate regarding off-pump coronary artery bypass grafting (CABG) and on-pump CABG has endured for over three decades. Although numerous randomized controlled trials (RCTs) and meta-analyses have been reported, new evidence has emerged. Therefore, an updated and comprehensive meta-analysis to guide clinical practice is essential.
METHODS: A comprehensive search for eligible articles published after 2000, reporting RCTs involving at least 100 patients and comparing off-pump CABG with on-pump CABG, was performed throughout the databases including Embase, Ovid Medline, and Web of Science. The primary interested outcomes included the short-term incidence of stroke and long-term mortality. The primary analysis utilized fixed-effect model with the inverse variance method. The Grade of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence.
RESULTS: After thorough screening, 39 articles were included, consisting of 28 RCTs and involving a total of 16 090 patients. Off-pump CABG significantly reduced the incidence of short-term stroke (1.27 vs. 1.78%, OR: 0.74, P =0.03, high certainty). However, it was observed to be associated with increased mid-term coronary reintervention (2.77 vs. 1.85%, RR: 1.49, P <0.01, high certainty) and long-term mortality (21.8 vs. 21.0%, RR: 1.09, P =0.02, moderate certainty).
CONCLUSIONS: Off-pump CABG significantly reduces the short-term incidence of stroke, but it also increases the incidence of mid-term coronary reintervention. Moreover, it may increase long-term mortality.