比较经皮冠状动脉介入治疗与药物治疗对稳定性冠心病患者预后影响的荟萃分析

Impact of percutaneous coronary intervention versus medical therapy on mortality in stable coronary artery disease： a meta-analysis

目的 比较经皮冠状动脉介入治疗（PCI）与单纯药物治疗对稳定性冠心病患者预后的影响.方法 检索PubMed、Embase、Cochrane central register of controlled trials、万方数据库、中国知网中2013年12月之前,对比PCI与单纯药物治疗对稳定性冠心病患者预后影响的英文和中文临床随机对照试验.按纳入与排除标准选择文献,提取资料.采用STATA 12.0软件对数据进行荟萃分析.结果 共纳入5篇随机对照试验,共5 567例患者.荟萃分析显示：在稳定性冠心病患者中,单纯药物治疗与PCI之间的远期全因死亡发生率（RR =0.96,95％ CI 0.80～1.15）、心原性死亡发生率（RR=1.02,95％ CI 0.77 ～ 1.36）、心肌梗死率（RR=1.05,95％ CI 0.89 ～ 1.23）、急性冠状动脉综合征发生率（RR =0.70,95％ CI 0.27～ 1.82）、心绞痛症状缓解率（RR=1.09,95％ CI 0.98 ～ 1.21）和卒中率（RR=1.27,95％ CI 0.75～2.15）差异均无统计学意义;行PCI患者血运重建率低于单纯药物治疗（RR =0.60,95％ CI 0.42 ～0.86）.结论 稳定性冠心病患者的PCI远期预后不优于单纯药物治疗.

Objective To compare the impacts of percutaneous coronary intervention （PCI） and medical therapy on mortality in patients with stable coronary artery disease.Methods We searched PubMed,Embase,Cochrane central register of controlled trials,Wanfang data and CNKI to find relevant randomized controlled trials on PCI versus medical therapy for treating patients with stable coronary artery disease,which were reported before December 2013.Publications were selected according to inclusion and exclusion standard.Meta-analyses was performed with the software of STATA 12.0.Results Five randomized controlled trials and 5 567 patients were enrolled for this analysis.Compared with medical therapy,PCI could not significantly decrease the long-term all-cause mortality （RR =0.96,95％ CI 0.80-1.15）,the cardiac death rate （RR =1.02,95％ CI 0.77-1.36）,the myocardial infarction rate （RR =1.05,95％ CI 0.89-1.23）,the acute coronary syndrome （RR =0.70,95％ CI 0.27-1.82）,the rate of freedom from angina （RR =1.09,95％ CI0.98-1.21）,and the rate of stroke （RR =1.27,95％ CI 0.75-2.15）.However,the revascularization rate was significantly lower for patients in PCI group （RR =0.60,95％ CI 0.42-0.86）.Conclusions Long-term mortality is similar for patients with stable coronary artery disease underwent PCI or medical therapy.