Meta-analysis of percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with diabetes and left main and/or multivessel coronary artery disease
Meta-analysis of percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with diabetes and left main and/or multivessel coronary artery disease
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糖尿病合并左主干和/或多支冠状动脉疾病患者经皮冠状动脉介入治疗与冠状动脉搭桥手术的荟萃分析
DOI：
10.1007/s00592-012-0411-4
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发表时间：
2013-10-01
影响因子：
3.8
通讯作者：
Liu，Xiao Li
中科院分区：
文献类型：
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作者：
Gao，Fei;Zhou，Yu Jie;Liu，Xiao Li
糖尿病合并左主干和/或多支血管疾病患者的最佳冠状动脉血运重建策略尚不确定。我们研究的目的是评估经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）在这些患者中的应用。我们选取了2011年10月前发表的13篇文章，纳入6992例患者，随访时间为1 - 5年。与CABG相比，PCI患者的脑血管发作（CVA）显著降低（OR, 0.29; 95% CI, 0.16-0.51;p< 0.0001,I2= 0%），然而，即使使用药物洗脱支架，PCI相关的重复血运重建风险增加了4倍（OR, 4.44; 95% CI, 3.42-5.78； Χ2= 4.92,p< 0.00001,I2= 0%）。PCI和CABG的总死亡率（OR, 0.97; 95% CI, 0.81-1.15;p= 0.70,I2= 0%）具有可比性。然而，在亚组分析中，有利于DES植入的复合结局（死亡/心肌梗死/CVA）显著降低（OR, 0.79; 95% CI, 0.63-0.99； Χ2= 1.07,p= 0.04,I2= 0%）。我们的研究通过显著降低CVA风险证实了PCI对脑血管的益处，并且药物洗脱支架行PCI患者的复合结局更好，尽管重复血运重建率更高。这对未来的前瞻性随机研究提出了迫切的要求，以确定糖尿病和左主干和/或多血管疾病患者的最佳策略。
The optimal coronary revascularization strategy for patients with diabetes and left main and/or multivessel disease is undetermined. The aim of our study was to evaluate percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in those patients. We identified 13 articles, published before October 2011, enrolling 6992 patients, whose follow-up period ranged from 1 to 5 years. Patients with PCI had a significant reduction in cerebral vascular attack (CVA) (OR, 0.29; 95 % CI, 0.16–0.51;p< 0.0001,I2= 0 %) as compared with CABG, whereas there was a fourfold increased risk of repeat revascularization associated with PCI even using drug-eluting stent (OR, 4.44; 95 % CI, 3.42–5.78; Χ2= 4.92,p< 0.00001,I2= 0 %). The overall mortality (OR, 0.97; 95 % CI, 0.81–1.15;p= 0.70,I2= 0 %) was comparable between the PCI and CABG. However, in subgroup analysis, the composite outcome (death/myocardial infarction/CVA) was significantly reduced in favor of DES implantation (OR, 0.79; 95 % CI, 0.63–0.99; Χ2= 1.07,p= 0.04,I2= 0 %). Our study confirmed the cerebral vascular benefits of PCI by significantly reducing CVA risks, and the composite outcome was better in patients undergoing PCI with drug-eluting stent, despite a higher repeat revascularization rate. It poses imperative demands for future prospective randomized studies to define the optimal strategy in patients with diabetes and left main and/or multivessel disease.