A meta-analysis of adjusted risk estimates for survival from observational studies of complete versus incomplete revascularization in patients with multivessel disease undergoing coronary artery bypass grafting
A meta-analysis of adjusted risk estimates for survival from observational studies of complete versus incomplete revascularization in patients with multivessel disease undergoing coronary artery bypass grafting
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DOI：
10.1093/icvts/ivu012
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发表时间：
2014-05-01
影响因子：
--
通讯作者：
Umemoto, Takuya
中科院分区：
文献类型：
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作者：
Takagi, Hisato;Watanabe, Taku;Umemoto, Takuya
为了确定与不完全血运重建的冠状动脉旁路移植术相比，完全血运重建的冠状动脉旁路移植术（CABG）是否能改善多支血管疾病（MVD）患者的生存率，我们对观察性研究中校正（但非未校正）的风险估计进行了荟萃分析。使用基于网络的搜索引擎（PubMed、奥维德）检索了截至2013年10月的数据库，包括MEDLINE和EMBASE。合格的研究是完全与不完全血运重建CABG的观察性研究，每个治疗组入组的MVD患者为千分之一，并报告了随访死亡率的校正风险比。进行混合效应荟萃回归分析，以确定完全血运重建CABG对生存率的影响是否受到预先设定的因素的调节。确定并纳入了14项观察性研究，共招募了30389例患者。一项汇总分析表明，与不完全血运重建CABG相比，完全血运重建CABG的随访死亡率降低了37%，具有统计学意义（风险比，0.63; 95%置信区间，0.53-0.75; P < 0.00001）。尽管荟萃回归系数在平均随访时间、年龄、男性比例和接受非体外循环CABG的患者比例方面无统计学显著性，但糖尿病患者比例的荟萃回归系数显著为负（P = 0.03），这表明随着糖尿病患者的增加，完全血运重建CABG更有利于生存。总之，在MVD患者中，完全血运重建CABG似乎比不完全血运重建CABG更能提高生存率。
To determine whether coronary artery bypass grafting (CABG) with complete revascularization improves survival in patients with multivessel disease (MVD) over CABG with incomplete revascularization, we performed a meta-analysis of adjusted (but not unadjusted) risk estimates from observational studies. Databases including MEDLINE and EMBASE were searched through October 2013 using Web-based search engines (PubMed, OVID). Eligible studies were observational studies of complete- versus incomplete-revascularization CABG enrolling a parts per thousand yen100 patients with MVD in each treatment arm and reporting an adjusted hazard ratio for follow-up mortality. Mixed-effects meta-regression analyses were performed to determine whether the effects of complete-revascularization CABG on survival were modulated by the prespecified factors. Fourteen observational studies enrolling 30 389 patients were identified and included. A pooled analysis demonstrated a statistically significant 37% reduction in follow-up mortality with complete- relative to incomplete-revascularization CABG (hazard ratio, 0.63; 95% confidence interval, 0.53-0.75; P < 0.00001). Although meta-regression coefficients were not statistically significant for mean follow-up duration and age and proportion of men and patients undergoing off-pump CABG, that for proportion of patients with diabetes was significantly negative (P = 0.03), which would indicate that as patients with diabetes increase, complete-revascularization CABG is more beneficial for survival. In conclusion, complete-revascularization CABG appears to improve survival over incomplete-revascularization CABG in patients with MVD.