微创复合式冠状动脉血运重建术与冠状动脉旁路移植术临床结果的Meta分析

Comparative study between hybrid coronary revascularization and coronary artery bypass graft:Meta-analysis

目的探讨微创复合式冠状动脉血运重建术（HCR）与传统冠状动脉旁路移植术（CABG）相比是否具备优越性。方法利用权威数据库EMBASE、PUBMED、CNKI检索相关文献,对比分析患者住院期间及1年死亡率、心肌梗死（MI）、休克、再次血运重建率、主要心脑血管不良事件等主要临床结果及输血、出血、心房颤动、肾衰竭等患者次要临床结果情况。结果 14个观察性研究（2个病例对照研究,12个倾向匹配研究）,包括6685例患者：848例（12.68%）患者接受HCR,5837例（87.31%）接受CABG治疗。HCR在住院时间（WMD-0.87 h,95%CI-1.78~0.04,P0.05）。结论 HCR对于将进行血运重建的冠状动脉病变是可行、安全、有效的手术方式。

Objective To compare the clinical outcomes between hybrid coronary revascularization （HCR） and coronary artery bypass graft （CABG）. Methods A comprehensive EMBASE, PUBMED and CNKI search was performed for comparative studies evaluating in-hospital and one-year primary outcomes [death, myocardial infarction （MI）, stoke, repeat revascularization, major adverse cardiac or cerebrovascular events （MACCEs）] and secondary endpoints [atrial fibrillation （AF）, renal failure, length of stay （LOS） in hospital, red blood cell （RBC） transfusion]. Results Fourteen observational studies （2 cases control studies, 12 propensity adjusted studies） comprising 6685 patients were included, 848 patients （12.68%） underwent HCR, and 5837 patients （87.31%） were treated with CABG. HCR was associated with short LoS in hospital （WMD -0.87 h, 95% C1 ＂1.78-0.04, P〈0.0001）, atrial fibrillation （RR 0.93, 95% CI 0.22-3.89, P〈0.0001） and lower requirement of RBC transfusion than CABG （weighted mean difference RR 1.04, 95% CI 0.33-3.33, P〈0.0001; respectively）. But HCR was non-inferior to CABG in terms of death, MI, stoke, repeat revascularization, MACCEs during hospitalization and at one-year follow-up （P〉0~05）. Conclusion This Meta-analysis suggests that HCR is feasible, safe and effective for patients with multivessel coronary artery disease undergoing coronary revascularization.