经皮冠状动脉介入术与冠状动脉旁路移植术治疗无保护左主干病变远期疗效的Meta分析

Effects of PCI and CABG on unprotected left main artery lesions:a Meta analysis

目的:比较经皮冠状动脉介入术(PCI)与冠状动脉旁路移植术(CABG)对无保护左主干病变(ULMCA)的远期疗效和安全性。方法:检索PubMed、EMBASE和Cochrane数据库,收集国内外公开发表的关于ULMCA行PCI与CABG术后长期随访的对比研究,研究的相关临床终点为全因死亡、心肌梗死、脑血管事件、靶血管血运重建。采用RevMan 5软件进行数据分析。结果:最终纳入文献8篇,共11 332例患者,3年以上随访结果显示,PCI组与CABG组全因死亡率(OR=1.02,95%CI:0.73~1.42,P=0.92)、脑血管事件发生率(OR=0.59,95%CI:0.33~1.07,P=0.08)差异无统计学意义,但PCI组心肌梗死率(OR=1.74,95%CI:1.43~2.11,P<0.000 01)、靶血管血运重建发生率(OR=2.60,95%CI:1.81~3.72,P<0.000 01)显著增高。亚组分析结果显示:5年随访,与CABG组相比,PCI组全因死亡率(OR=0.91,95%CI:0.64~1.28,P=0.59)轻微降低,脑血管事件发生率(OR=0.64,95%CI:0.28~1.48,P=0.29)无明显差异,但心肌梗死率(OR=2.08,95%CI:1.62~2.69,P<0.000 01)、靶血管血运重建发生率(OR=2.70,95%CI:1.80~4.03,P<0.000 01)仍显著增高。7年随访,与CABG组相比,PCI组全因死亡率(OR=0.61,95%CI:0.46~0.80,P=0.000 4)、脑血管事件发生率(OR=0.23,95%CI:0.16~0.32,P<0.000 01)均显著降低,心肌梗死率(OR=2.00,95%CI:1.39~2.86,P=0.000 2)、靶血管血运重建发生率(OR=2.37,95%CI:1.65~3.41,P<0.000 01)仍显著增高。结论:PCI与CABG治疗ULMCA患者3年随访全因死亡率、脑血管事件发生率相当,但PCI心肌梗死率与靶血管血运重建发生率较高。分层分析后7年随访,与CABG相比,PCI全因死亡率、脑血管事件发生率均显著降低,心肌梗死率、靶血管血运重建发生率仍显著增高。

Objective：To compare the effects of percutaneous coronary intervention（PCI）and coronary artery bypass grafting（CABG）on unprotected left main artery lesions.Method：PubMed,EMBASE and Cochrane databases were searched to collect published randomized controlled trials about the long-term follow-up of ULMCA after PCI and CABG.The clinical endpoints of studies were all-cause death,myocardial infarction,cerebrovascular events,and revascularization of target blood vessels.The data were analyzed by RevMan 5 software.Result：Eight articles including a total of 11 332 patients were finally analyzed in the Meta-analysis.The results of follow-up more than 3 years showed that there was no significant difference in the all-cause death rate（OR=1.02,95%CI：0.73-1.42,P=0.92）and the incidence of cerebrovascular events（OR=0.59,95%CI：0.33-1.07,P=0.08）between PCI group and CABG group,but the myocardial infarction rate（OR=1.74,95%CI：1.43-2.11,P〈0.000 01）and the incidence of target vessel revascularization（OR=2.60,95%CI：1.81-3.72,P〈0.000 01）were increased significantly in PCI group.The results of subgroup analysis showed that the all-cause death rate was slightly decreased（OR=0.91,95%CI：0.64-1.28,P=0.000 4）and the incidence of cerebrovascular events had slightly increased（OR=0.64,95%CI：0.28-1.48,P=0.29）,while the myocardial infarction rate（OR=2.08,95%CI：1.62-2.69,P〈0.000 01）and the incidence of target vessel revascularization（OR=2.70,95%CI：1.80-4.03,P〈0.000 01）were increased significantly in PCI group.After 7 years follow-up,compared with CABG group,the all-cause death rate（OR=0.61,95%CI：0.46-0.80,P=0.000 4）and the incidence of cerebrovascular events（OR=0.23,95%CI：0.16-0.32,P〈0.000 01）were decreased significantly,while the myocardial infarction rate（OR=2.00,95%CI：1.39-2.86,P=0.000 2）and the incidence of target vessel revascularization（OR=2.37,95%CI：1.65-3.41,P〈0.000 01）were increased significantly in PCI group.Conclusion：The all-death rate and the incidence of cerebrovascular events within 3 years in patients with ULMCA treated with PCI and CABG are comparable,but the myocardial infarction rate and the incidence of target vessel revascularization increase significantly in PCI group.After 7 years of follow-up,compare with CABG,the mortality rate and the incidence of cerebrovascular events of PCI are reduce significantly,but the myocardial infarction rate and the incidence of target vessel revascularization still increase significantly.