对比较冠状动脉旁路移植术(CABG)的研究进行系统评价和荟萃分析,经皮冠状动脉介入治疗(PCI),慢性完全闭塞(CTO)患者的药物治疗(MT)。
我们确定了发表在中国国家知识基础设施数据库中的合格观察研究,PubMed,摘录医疗数据库,谷歌学者,科克伦图书馆,WebofScience,和1999年至2018年10月的“临床试验”注册。主要结果指标是全因死亡率,心脏死亡,主要不良心脏事件(MACE),心肌梗死(MI)。
共有8项观察性研究,包括6985名患者。患者的平均年龄为64.4岁。平均随访时间为4.3年。与MT(2958例)相比,PCI(3157例)显示全因死亡率降低(奇数比[OR]:0.46,95%置信区间[CI]:0.36-0.60;P<0.001),心源性死亡(OR:0.40,95%CI:0.31-0.52;P<0.001),MACE(OR:0.55,95%CI:0.43-0.71;P<0.001),和MI(OR:0.40,95%CI:0.26-0.62;P<0.001)。与MT相比,CABG(613例)的全因死亡率(OR:0.50,95%CI:0.36-0.69;P<0.001)和MACE(OR:0.50,95%CI:0.26-0.96;P=0.04)较低,但不能降低MI(OR:0.23,95%CI:0.03-1.54;P=0.13)和心源性死亡(OR:0.83,95%CI:0.51-1.35)。与CABG相比,PCI并没有降低这些结果的风险。
PCI或CABG与CTO患者比MT患者更好的临床预后相关。PCI在降低死亡率方面并不优于CABG,MI,心脏死亡,冠状动脉CTO患者的MACE。
To perform a systematic review and meta-analysis of studies comparing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical treatment (MT) in patients with chronic total occlusions (CTOs).
We identified eligible observational studies published in the
China National Knowledge Infrastructure database, PubMed, Excerpta Medica database, Google Scholar, Cochrane Library, Web of Science, and \"Clinical trials\" registration from 1999 to October 2018. Main outcome measures were all-cause mortality, cardiac death, major adverse cardiac events (MACEs), and myocardial infarction (MI).
There were eight observational studies including 6985 patients. Patients\' mean age was 64.4 years. Mean follow-up time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients) presented decreased all-cause mortality (odd ratio [OR]: 0.46, 95% confidence interval [CI]: 0.36-0.60; P<0.001), cardiac death (OR: 0.40, 95% CI: 0.31-0.52; P<0.001), MACE (OR: 0.55, 95% CI: 0.43-0.71; P<0.001), and MI (OR: 0.40, 95% CI: 0.26-0.62; P<0.001). Comparing with MT, CABG (613 patients) presented lower all-cause mortality (OR: 0.50, 95% CI: 0.36-0.69; P<0.001) and MACE (OR: 0.50, 95% CI: 0.26-0.96; P=0.04), but not lower MI (OR: 0.23, 95% CI: 0.03-1.54; P=0.13) and cardiac death (OR: 0.83, 95% CI: 0.51-1.35). Comparing with CABG, PCI did not present decreased risk for those outcomes.
PCI or CABG was associated with better clinical outcome in patients with CTO than MT. PCI is not better than CABG in decreasing mortality, MI, cardiac death, and MACE in coronary CTO patients.