杂交冠状动脉血运重建术与CABG治疗多支冠状动脉疾病中远期随访的Meta分析

Meta-analysis of long-term follow-up of hybrid coronary artery revascularization and coronary artery bypass grafting in the treatment of multiple coronary artery disease

目的系统评价杂交冠状动脉血运重建术(HCR)与冠状动脉旁路移植术(CABG)治疗多支冠状动脉疾病中远期疗效与并发症。方法系统检索Embase、PubMed、Web of Science、Cochrane Central Registry of Controlled Trials(Central)、万方数据、中国知网,筛选符合纳入标准的文献,并计算每项研究中的比值比(odds ratio,OR)和95%置信区间(95%CI),采用RevMan 5.3软件进行Meta分析。结果9篇文献纳入研究,累计研究对象4030例,其中1142例接受HCR治疗,2888例接受传统CABG治疗。Meta分析结果显示:(1)中远期随访中HCR组术后全因病死率(OR=0.72,95%CI:0.54~0.96)和主要心脑血管事件(MACCE,OR=0.54,95%CI:0.35~0.82)均低于CABG组。而在血运重建(OR=0.90,95%CI:0.61~1.34)及心肌梗死或心绞痛发生率(OR=0.51,95%CI:0.18~1.41)方面差异无统计学意义。(2)中期随访中HCR组的MACCE发生率低于CABG组(OR=0.31,95%CI:0.15~0.66),而全因病死率(OR=0.79,95%CI:0.52~1.22)、血运重建(OR=0.77,95%CI:0.30~1.96)以及心肌梗死或心绞痛发生率(OR=0.71,95%CI:0.05~9.46)等差异无统计学意义。(3)远期随访中HCR组术后全因病死率(OR=0.67,95%CI:0.46~0.98)及心肌梗死或心绞痛发生率(OR=0.32,95%CI:0.15~0.68)均低于CABG组。而在MACCE(OR=0.72,95%CI:0.43~1.21)与血运重建(OR=0.93,95%CI:0.60~1.45)方面差异无统计学意义。结论HCR相比CABG可降低多支冠状动脉病变患者的中期MACCE和远期全因病死率、心肌梗死或心绞痛发生率。

Objective To systematically evaluate the long-term efficacy and complications of hybrid coronary artery revascularization(HCR)and coronary artery bypass grafting(CABG)in the treatment of the multiple coronary artery disease.Methods The databases of Embase,PubMed,Web of Science,Cochrane Central Registry of Controlled Trials(Central),Wanfang Data and China Knowledge Network were systematically searched.The documents that met the inclusion criteria were screened,and the odds ratio(OR)and 95%confidence interval(CI)were calculated.RevMan 5.3 software was used for meta-analysis.Results Nine articles were included in the study.A total of 4030 subjects were included,of which 1142 were treated with HCR and 2888 were treated with conventional CABG.Postoperative mortality(OR=0.72,95%CI:0.54-0.96)and major cardiovascular and cerebrovascular events(MACCE,OR=0.54,95%CI:0.35-0.82)were lower in HCR group than those of CABG group in the mid-and long-term follow-up.There were no significant differences in the revascularization(OR=0.90,95%CI:0.61-1.34)and the incidence of angina(OR=0.51,95%CI:0.18-1.41)between the two groups.In the midterm follow-up,the incidence of MACCE was lower in the HCR group than that in the conventional group(OR=0.31,95%CI:0.15-0.66),while there were no significant differences in the mortality(OR=0.79,95%CI:0.52-1.22),revascularization(OR=0.90,95%CI:0.61-1.34)and the incidence of myocardial infarction angina(OR=0.71,95%CI:0.05-9.46)between the two groups.In the long-term follow-up,the postoperative mortality(OR=0.67,95%CI:0.54-0.96)and the incidence of myocardial infarction angina(OR=0.32,95%CI:0.15-0.68)were significantly lower in HCR group than those of the CABG group.There were no significant differences in MACCE(OR=0.72,95%CI:0.43-1.21)and revascularization(OR=0.93,95%CI:0.60-1.45)between the two groups.Conclusion Compared with CABG,HCR can reduce the medium-term MACCE,long-term all-cause mortality and myocardial infarction/angina pectoris in patients with multi-vessel coronary artery disease.