Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis
Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis
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DOI：
10.1016/s0140-6736(21)02334-5
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发表时间：
2021-12-16
期刊：
影响因子：
168.9
通讯作者：
Braunwald, Eugene
中科院分区：
文献类型：
--
作者：
Sabatine, Marc S.;Bergmark, Brian A.;Braunwald, Eugene
背景左主干冠状动脉疾病患者的最佳血运重建策略尚不确定。因此，我们的目的是评估长期的结果，经皮冠状动脉介入治疗（PCI）与药物洗脱支架与冠状动脉旁路移植术（CABG）治疗的患者。方法在这一个体患者数据荟萃分析，我们检索MEDLINE，Embase，和科克伦数据库使用的检索词“左主干”，“经皮冠状动脉介入治疗”或“支架”，和“冠状动脉旁路移植术 *”，以识别数据库建立至2021年8月31日期间以英文发表的随机对照试验（RCT），在至少随访5年的左主干冠状动脉疾病患者中比较PCI与药物洗脱支架联合CABG-导致死亡。两位作者（MSS和BAB）确定了符合标准的研究。主要终点是5年全因死亡率。次要终点为心血管死亡、自发性心肌梗死、手术性心肌梗死、卒中和重复血运重建。我们采用一阶段方法;使用Kaplan-Meier方法计算事件发生率，使用考克斯脆弱模型进行治疗组比较，试验作为随机效应。在贝叶斯分析中，PCI和CABG之间的主要终点的绝对风险差异的概率超过0. 0%，至少1. 0%，2. 5%，或5. 0%，calculated.Findings我们的文献检索产生了1599结果，其中四个随机对照试验，SYNTAX，PRECOMBAT，NOBLE，和EXCEL符合我们的纳入标准被列入我们的荟萃分析。4394例患者（中位SYNTAX评分为25.0（IQR 18.0-31.0））被随机分配接受PCI（n=2197）或CABG（n=2197）。PCI组5年全因死亡的Kaplan-Meier估计值为11.2%（95% CI 9.9-12.6），CABG组为10.2%（9.0-11.6）（风险比1.10，95% CI 0.91-1.32; p=0.33），导致0.9%（95% CI -0.9至2.8）的非统计学显著绝对风险差异。在贝叶斯分析中，PCI组5年死亡率高于CABG组的可能性为85.7%;该差异可能大于不低于1.0%（
Background The optimal revascularisation strategy for patients with left main coronary artery disease is uncertain. We therefore aimed to evaluate long-term outcomes for patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents versus coronary artery bypass grafting (CABG).Methods In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane database using the search terms "left main", "percutaneous coronary intervention" or "stent", and "coronary artery bypass graft*" to identify randomised controlled trials (RCTs) published in English between database inception and Aug 31, 2021, comparing PCI with drug-eluting stents with CABG in patients with left main coronary artery disease that had at least 5 years of patient follow-up for all-cause mortality. Two authors (MSS and BAB) identified studies meeting the criteria. The primary endpoint was 5-year all-cause mortality. Secondary endpoints were cardiovascular death, spontaneous myocardial infarction, procedural myocardial infarction, stroke, and repeat revascularisation. We used a one-stage approach; event rates were calculated by use of the Kaplan-Meier method and treatment group comparisons were made by use of a Cox frailty model, with trial as a random effect. In Bayesian analyses, the probabilities of absolute risk differences in the primary endpoint between PCI and CABG being more than 0.0%, and at least 1.0%, 2.5%, or 5.0%, were calculated.Findings Our literature search yielded 1599 results, of which four RCTs-SYNTAX, PRECOMBAT, NOBLE, and EXCEL-meeting our inclusion criteria were included in our meta-analysis. 4394 patients, with a median SYNTAX score of 25.0 (IQR 18.0-31.0), were randomly assigned to PCI (n=2197) or CABG (n=2197). The Kaplan-Meier estimate of 5-year all-cause death was 11.2% (95% CI 9.9-12.6) with PCI and 10.2% (9.0-11.6) with CABG (hazard ratio 1.10, 95% CI 0.91-1.32; p=0.33), resulting in a non-statistically significant absolute risk difference of 0.9% (95% CI -0.9 to 2.8). In Bayesian analyses, there was an 85.7% probability that death at 5 years was greater with PCI than with CABG; this difference was more likely than not less than 1.0% (