摘要
目的:系统评价高龄(年龄 ≥ 75岁)患者冠状动脉旁路移植术(coronary artery bypass grafting, CABG)与行经皮冠状动脉介入(percutaneous coronary intervention, PCI)下置入药物洗脱支架(drug eluting stent, DES)术后近远期疗效。方法:利用计算机检索MEDLINE(via pubmed,建库至2017年2月)、EMBASE (建库至2017年2月)、Cochrane Library (建库至2017年2月),并辅助以手动检索会议记录或灰色文献,收集研究高龄患者CABG与PCI下置入DES术后死亡率、主要不良心脑血管事件(main adverse cardiovascular and cerebrovascular events, MACCE)、心肌梗死(myocardial infarction, MI)以及靶病变再次血运重建(target lesion revascularization, TLR)发生率对比的英文文献资料。采用Review Manager 5.3软件进行meta分析。结果:共纳入12篇文献进入meta分析,均为观察性研究,未检索到随机对照研究(randomized controlled study, RCT)。本meta分析共纳入6877例患者,其中CABG组3460例(50.31%)。Meta分析结果表明:两组患者术后远期死亡率(OR = 1.29, 95%CI (1.07, 1.57), P = 0.009)以及TLR发生率(OR = 5.88, 95%CI (4.68,7.38), P <0.00001)的差异具有统计学意义,院内死亡率(OR = 0.78, 95%CI (0.56,1.08), P = 0.14)、MACCE发生率(OR = 1.01, 95%CI (0.88, 1.17), P = 0.87)以及MI发生率(OR = 1.25, 95%CI (0.68, 2.30), P = 0.46)差异不具有统计学意义。结论:与PCI相比,CABG能明显减低高龄患者术后远期死亡率以及血运重建发生率,但仍有待于更多更大的随机对照试验以进一步验证。
Objective: To evaluate the near-long-term efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in the elderly (age ≥ 75 years). Methods: We searched relevant literatures in MEDLINE (via pubmed), EMBASE, Cochrane Library from the time of building to 2017. Meanwhile, we collected conference records or gray literature from cardiovascular con-gresses to compare CABG and PCI for elderly patients. Meta analysis was performed using Review Manager 5.3 software. Results: A total of 12 articles were included in the meta-analysis, all of which were observational studies and randomized controlled studies (RCTs) were not retrieved. A total of 6877 patients were enrolled in this meta-analysis, of which 3460 (50.31%) were CABG. Meta- anal-ysis showed that the long-term mortality rate (OR = 1.29, 95% CI (1.07, 1.57), P = 0.009) and the in-cidence rate of revascularization (OR = 5.88, 95% CI (4.68, 7.38).
出处
《外科(汉斯)》
2017年第3期21-30,共10页
Hans Journal of Surgery