Angiographic Patency of Coronary Artery Bypass Conduits: A Network Meta-Analysis of Randomized Trials.
Angiographic Patency of Coronary Artery Bypass Conduits: A Network Meta-Analysis of Randomized Trials.
复制标题
DOI：
10.1161/jaha.120.019206
复制
发表时间：
2021-03-16
影响因子：
5.4
通讯作者：
E Fremes S
中科院分区：
文献类型：
--
作者：
Gaudino M;Hameed I;Robinson NB;Ruan Y;Rahouma M;Naik A;Weidenmann V;Demetres M;Y Tam D;Hare DL;Girardi LN;Biondi-Zoccai G;E Fremes S
几项随机试验比较了冠状动脉搭桥术的通畅性。然而，所有已发表的研究都进行了成对比较，所有管道的通畅率的综合评估尚未发表。我们开始通过对现有随机证据进行网络荟萃分析来调查冠状动脉搭桥术中使用的所有导管的血管造影通畅率。采用系统的文献检索方法进行随机对照试验，比较常规采集的大隐静脉、非接触性大隐静脉、桡动脉(RA)、右胸内动脉或胃网膜动脉的血管造影通畅率。主要结果是移植物闭塞。共检索到4160项研究，其中14项纳入，分析了3651个移植物。加权平均血管造影随访时间为5.1年。与常规切取的大隐静脉相比，RA(发生率比0.54；95%CI，0.35~0.82)和非接触性大隐静脉(IRR 0.55；95%CI，0.39~0.78)的移植物闭塞率较低。RA是最好的管道(RA评分为0.87分，非接触大隐静脉为0.85分，右胸内动脉为0.23分，胃网膜动脉为0.29分，常规采集的大隐静脉为0.25分)。与常规采集的大隐静脉相比，只有RA和非接触性大隐静脉移植物的移植物闭塞率显著降低。RA被评为最佳渠道。网址：https://www.crd.york.ac.uk/prospero；唯一标识：CRD42020164492。
Several randomized trials have compared the patency of coronary artery bypass conduits. All of the published studies, however, have performed pairwise comparisons and a comprehensive evaluation of the patency rates of all conduits has yet to be published. We set out to investigate the angiographic patency rates of all conduits used in coronary bypass surgery by performing a network meta‐analysis of the current available randomized evidence. A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency rate of the conventionally harvested saphenous vein, the no‐touch saphenous vein, the radial artery (RA), the right internal thoracic artery, or the gastroepiploic artery. The primary outcome was graft occlusion. A total of 4160 studies were retrieved of which 14 were included with 3651 grafts analyzed. The weighted mean angiographic follow‐up was 5.1 years. Compared with the conventionally harvested saphenous vein, both the RA (incidence rate ratio [IRR] 0.54; 95% CI, 0.35–0.82) and the no‐touch saphenous vein (IRR 0.55; 95% CI, 0.39–0.78) were associated with lower graft occlusion. The RA ranked as the best conduit (rank score for RA 0.87 versus 0.85 for no‐touch saphenous vein, 0.23 for right internal thoracic artery, 0.29 for gastroepiploic artery, and 0.25 for the conventionally harvested saphenous vein). Compared with the conventionally harvested saphenous vein, only the RA and no‐touch saphenous vein grafts are associated with significantly lower graft occlusion rates. The RA ranks as the best conduit. URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42020164492.