目的:我们探索了目前关于冠状动脉外科最佳第二导管的证据,进行了一项关于双侧胸廓内动脉(BITA)与单个胸廓内动脉加桡动脉的倾向评分匹配或调整研究的双重荟萃分析。
方法:PubMed,Embase,和GoogleScholar进行了比较BITA与单个胸廓内动脉加桡动脉的倾向评分匹配或调整的研究。终点是长期死亡率。使用了两种统计方法:通用逆方差方法和Kaplan-Meier衍生的个体患者数据的汇总荟萃分析。
结果:我们的meta分析纳入了12个匹配人群,比较了6450例BITA患者和9428例单胸内动脉加桡动脉患者。通用逆方差方法显示,BITA组的生存获益具有统计学意义(风险比,0.84;95%CI,0.74-0.95;P=.04)。BITA组1、5、10和15年生存率的Kaplan-Meier估计为97.0%,91.3%,80.0%,68.0%,分别。Kaplan-Meier估计的1、5、10和15年单内胸动脉加桡动脉组的生存率为97.3%,91.5%,79.9%,和63.9%,分别。Kaplan-Meier衍生的个体患者数据荟萃分析应用于非常长的随访时间数据,显示BITA在手术后10年提供了生存益处(风险比,0.77;95%CI,0.63-0.94;P=0.01)。当分析集中在随访的前10年时,两组之间的生存率没有差异(风险比,0.99;95%CI,0.91-1.09;P=.93)。
结论:本荟萃分析提示胸廓内动脉可以提供,与单个胸廓内动脉加桡动脉相比,经过10年的随访,具有统计学上的显着生存优势,但不是以前。视频摘要.
We explored the current evidence on the best second conduit in coronary surgery carrying out a double meta-analysis of propensity score matched or adjusted studies comparing bilateral internal thoracic artery (BITA) versus single internal thoracic artery plus radial artery.
PubMed, Embase, and Google Scholar were searched for propensity score matched or adjusted studies comparing BITA versus single internal thoracic artery plus radial artery. The end point was long-term mortality. Two statistical approaches were used: the generic inverse variance method and the pooled meta-analysis of Kaplan-Meier-derived individual patient data.
Twelve matched populations comparing 6450 patients with BITA versus 9428 patients with single internal thoracic artery plus radial artery were included in our meta-analysis. The generic inverse variance method showed a statistically significant survival benefit of the BITA group (hazard ratio, 0.84; 95% CI, 0.74-0.95; P = .04). The Kaplan-Meier estimates of survival at 1, 5, 10, and 15 years of the BITA group were 97.0%, 91.3%, 80.0%, and 68.0%, respectively. The Kaplan-Meier estimates of survival at 1, 5, 10, and 15 years of the single internal thoracic artery plus radial artery group were 97.3%, 91.5%, 79.9%, and 63.9%, respectively. The Kaplan-Meier-derived individual patient data meta-analysis applied to very long follow-up time data, showed that BITA provided a survival benefit after 10 years from surgery (hazard ratio, 0.77; 95% CI, 0.63-0.94; P = .01). No differences in terms of survival between the 2 groups were detected when the analysis was focused on the first 10 years of follow-up (hazard ratio, 0.99; 95% CI, 0.91-1.09; P = .93).
The present meta-analysis suggests that double internal thoracic artery may provide, compared with single internal thoracic artery plus radial artery, a statistically significant survival advantage after 10 years of follow-up, but not before. VIDEO ABSTRACT.