药物洗脱支架与冠状动脉旁路移植术治疗多支冠状动脉病变的Meta分析

Meta-analysis of drug-eluting stent implantation versus coronary artery bypass grafting for multi-vessel coronary disease

目的 系统评价药物洗脱支架与冠状动脉旁路移植术（CABG）治疗多支冠状动脉病变的效果与安全性。方法 检索PubMed、Embase、SinoMed等数据库中国内外关于药物洗脱支架介入治疗（DES-PCI）和CABG治疗多支病变对比的临床研究,采用RevMan 5.2分析,主要结果为死亡、心肌梗死、脑血管事件等。结果 纳入12篇文献,31980例研究对象,结果显示DES-PCI组的病死率（OR=0.92,95%CI：0.84-1.00,P=0.06）、心肌梗死率（OR=1.14,95%CI：0.91-1.44,P=0.25）与CABG组比较差异无统计学意义,但DES-PCI组脑血管事件（OR=0.52,95%CI：0.38-0.72,P=0.002）、靶血管血运重建（OR=3.66,95%CI：2.23-5.76,P〈0.000 01）、主要不良心脑血管事件（OR=1.46,95%CI：1.00-2.14,P=0.05）显著增高。结论 DES-PCI与CABG在治疗多支冠状动脉病变上病死率与心肌梗死率相当,但使用DES-PCI的患者发生脑血管事件、靶血管血运重建与复合终点事件的风险较高。

Objective To evaluate the efficacy and safety of drug,eluting stent implantation and coronary artery bypass grafting, （CABG） in the treatment of patients with imuhi-vessel coronary disease systematically. Methods The data including the PubMed, Embase, SinoMed and other database was searched for clinical studies that reported outcomes comparing drug-eluting stent - percutaneous Coronary intervention （DES-PCI） with CABG in the treatment of multi- vessel coronary disease. The data was analyzed by RevMan 5.2. The primary outcomes were death, myocardial infarction, cerebrovascular accident and So on. Results Total 12 studies were included, involving 31 980 cases, which showed that, there were no significant differences between the DES-PCI group and CABG group in the risk of death （OR = 0.92, 95%CI： 0.84-1.00, P = 0.06） and myocardial infarction （OR = 1.14, 95%CI： 0.91-1.44, P = 0.25）. The risk of stroke （OR = 0.52,95%CI： 0.38-0.72, P = 0.002）, target vaseular reconstruction （OR = 3.66, 95%CI： 2.23-5.76, P 〈 0.000 01） and major adverse cardiac and eerebrovaseular events （OR = 1.46, 95%CI： 1.00-2.14, P = 0.05） in the DESPCI group was significantly increased. Conclusion DES-PCI and CABG in the treatment of multi-vessel coronary, disease has similar rates on death and myocardial infarction, but the patients taking DES-PCI have higher risk of stroke, target vascular reconstruction and major adverse cardiac and cerebrovascular events.