Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing.
Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing.
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DOI：
10.1016/j.amjcard.2017.03.009
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发表时间：
2017-06
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通讯作者：
Partha Sardar;Jay Giri;S. Elmariah;S. Chatterjee;D. Kolte;Amartya Kundu;Ramez Nairooz;W. Aronow;Theophilus E. Owan;D. Mukherjee;D. Feldman;J. Abbott
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作者：
Partha Sardar;Jay Giri;S. Elmariah;S. Chatterjee;D. Kolte;Amartya Kundu;Ramez Nairooz;W. Aronow;Theophilus E. Owan;D. Mukherjee;D. Feldman;J. Abbott
无保护左主干(ULMCA)疾病的患者越来越多地接受使用新一代药物洗脱支架(DES)的经皮冠状动脉介入治疗(PCI)；然而，与冠状动脉旁路移植(CABG)相比，DES在ULMCA中的优势仍然存在争议。这项荟萃分析评估了经皮冠状动脉介入治疗联合DES和冠状动脉旁路移植术治疗ULMCA狭窄的效果。对数据库的搜索一直持续到2016年11月30日。随机对照试验(RCT)比较DES、PCI和CABG治疗ULMCA狭窄。我们用随机效应模型计算了汇总优势比(OR)和95%的CI。主要结果是主要不良心血管事件，定义为由任何原因、中风或心肌梗死(MI)造成的死亡组成。这项分析包括来自5个随机对照试验的4612名患者。与冠脉搭桥术相比，接受经皮冠状动脉介入治疗的患者主要心血管事件发生率(OR 1.06，95%CI 0.79至1.43)、全因死亡率(OR 1.03，95%CI 0.79至1.35)、心血管死亡(OR 1.03，95%CI 0.73至1.45)、中风(OR 0.81，95%CI 0.38至1.76)和MI(OR 1.47，95%CI 0.87至2.47)的发生率相似。冠脉搭桥组再血管重建的风险显著高于冠脉搭桥组(OR 1.85，95%CI 1.53~2.24)。总之，我们对随机对照试验的荟萃分析表明，在ULMCA狭窄的血运重建方面，与冠状动脉旁路移植术相比，经皮冠状动脉介入治疗与冠状动脉旁路移植术相比，在死亡率、卒中和心肌梗死方面具有相似的结果，而经皮冠状动脉介入治疗与较高的重复血运重建率相关。
Patients with unprotected left main coronary artery (ULMCA) disease are increasingly treated with percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES); however, the benefits of DES compared with coronary artery bypass grafting (CABG) in ULMCA remain controversial. This meta-analysis evaluated the effects of PCI with DES compared with CABG for the treatment of ULMCA stenosis. Databases were searched through November 30, 2016. Randomized controlled trials (RCTs) comparing DES with PCI versus CABG for ULMCA stenosis were identified. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The primary outcome was major adverse cardiovascular events, defined as a composite of death from any cause, stroke, or myocardial infarction (MI). The analysis included 4,612 patients from 5 RCTs. Compared with CABG, patients assigned to PCI had a similar rate of major adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03, 95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR 1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was significantly greater in the PCI group than that in the CABG group (OR 1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs suggest that PCI with DESáresults in comparable mortality, stroke, and MI compared with CABG for revascularization of ULMCA stenosis, with PCI associated with higher rates of repeat revascularization.