应用杂交技术与冠状动脉旁路移植术治疗中国人群冠状动脉多支病变疗效的Meta分析

Effect of hybrid coronary revascularization versus coronary artery bypass grafting for Chinese patients with multivessel coronary artery disease:a meta-analysis

目的系统评价应用杂交冠状动脉血运重建术(HCR)与传统冠状动脉旁路移植术(CABG)治疗中国人群冠状动脉多支病变的有效性和安全性及其经济价值。方法计算机检索Pub Med、The Cochrane Library(2016年2期)、WanFang Data、CNKI、Web of Science数据库,搜集以国内人群为研究对象并且应用HCR与CABG治疗冠状动脉多支血管病变的病例-对照研究,检索时限均为1996年1月到2016年4月。由2位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.1软件进行Meta分析。结果共纳入9个研究,共计1 231例患者。Meta分析结果显示:HCR组在ICU时间[MD=–25.84,95%CI(–42.55,–9.13),P=0.002]和机械通气时间[MD=–4.06,95%CI(–6.43,–1.69),P=0.000 8]明显短于CABG组,但在术后住院时间[MD=–0.64,95%CI(–2.53,–1.25),P=0.51]、新发房颤发生率[OR=1.41,95%CI(0.86,2.30),P=0.17]以及肾损伤发生率[OR=1.56,95%CI(0.89,2.74),P=0.12],两组差异没有统计学意义;HCR组住院费用[MD=3.42,95%CI(1.27,5.56),P=0.002]高于CABG组。两组在术后死亡率[OR=0.36,95%CI(0.12,1.11),P=0.07]、术后再发心梗率[OR=0.32,95%CI(0.06,1.85),P=0.20]、及再血管化发生率[OR=1.16,95%CI(0.48,2.76),P=0.74]之间差异没有统计学意义。在术后脑血管意外[OR=0.35,95%CI(0.14,0.91),P=0.03]和主要不良心血管事件[OR=0.37,95%CI(0.20,0.70),P=0.002]方面,HCR组的发生率明显低于CABG组患者。结论当前证据表明,HCR比CABG在治疗后的脑血管意外和MACCEs发生率要低,但其在安全性和有效性方面,两组差异无统计学意义。受纳入研究数量和质量的限制,上述结论尚需要开展更多研究予以证实。

Objective To systematically review the efficacy, safety and economic value of hybrid coronary revascularization （HCR） versus coronary artery bypass grafting （CABG） for Chinese patients with multivessel coronary artery disease. Methods We searched PubMed, WanFang Data, CNKI, Web of Science and The Cochrane Library （Issue 2, 2016） to collect case-control studies about HCR versus CABG for Chinese patients with coronary multivessel disease from the January 1996 to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies, involving 1 231 patients were included. The results of meta-analysis showed that： compared with the CABG groups, HCR group had lower length of ICU stay （MD=-25.84, 95% C1-42.55 to -9.13, P=0.002） and intubation time （MD=-4.06, 95% CI -6.43 to -1.69, P=0.000 8）. However, there were no significant differences between both groups in the length of hospital stay （MD=-0.64, 95% CI-2.53 to 1.25, P=0.51）, the incidence of atrial fibrillation （OR=1.41, 95% CI 0.86 to 2.30, P=0.17）and renal failure （OR=1.56, 95% CI 0.89 to 2.74, P=0.12）. No significant differences were found between both groups in mortality （OR=0.36, 95% CI 0.12 to 1.11, P=0.07）, the incidence of myocardial infarction （OR=0.32, 95% CI 0.06 to 1.85, P=0.20） and the incidence of target vessel revascularization （OR= 1.16, 95% CI 0.48 to 2.76, P=0.74）. But the incidence of the stroke （OR=0.35, 95% CI 0.14 to 0.91, P=0.03） and MACCEs （OR=0.37, 95% CI 0.20 to 0.70, P=0.002） of the HCR group were lower than those of the patients of the CABG group. Conclusion The current evidence shows that, compared with the CABG groups, HCR had lower incidence of stroke and MACCEs, however, the safety and efficacy were not significantly different between both groups. Due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.