天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (7): 662-669.doi: 10.11958/20193274

• 循证医学 • 上一篇    下一篇

杂交冠状动脉血运重建术与CABG治疗多支冠状动脉疾病中远期随访的Meta分析

姚博宸1 ，白云鹏2 ，任珉3 ，姜楠2 ，王联群2 ，郭志刚2△   

  1. 1 天津医科大学研究生院（邮编 300070）；2 天津市胸科医院心脏外科：3 天津市心血管病研究所
  • 收稿日期:2019-10-31 修回日期:2020-03-11 出版日期:2020-07-15 发布日期:2020-07-16
  • 作者简介:姚博宸（1993），男，硕士在读，主要从事冠心病的外科治疗方面研究

Meta-analysis of long-term follow-up of hybrid coronary artery revascularization and coronary
artery bypass grafting in the treatment of multiple coronary artery disease

YAO Bo-chen1 , BAI Yun-peng2 , REN Min3 , JIANG Nan2 , WANG Lian-qun2 , GUO Zhi-gang2△   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of Cardiac Surgery, Tianjin Chest Hospital；3 Tianjin Cardiovascular Disease Institute
  • Received:2019-10-31 Revised:2020-03-11 Published:2020-07-15 Online:2020-07-16

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摘要： 目的 系统评价杂交冠状动脉血运重建术（HCR）与冠状动脉旁路移植术（CABG）治疗多支冠状动脉疾病 中远期疗效与并发症。方法 系统检索Embase、PubMed、Web of Science、Cochrane Central Registry of Controlled Trials （Central）、万方数据、中国知网，筛选符合纳入标准的文献，并计算每项研究中的比值比（odds ratio，OR）和95%置信 区间（95%CI），采用RevMan 5.3软件进行Meta分析。结果 9篇文献纳入研究，累计研究对象4 030例，其中1 142例 接受HCR治疗，2 888例接受传统CABG治疗。Meta分析结果显示：（1）中远期随访中HCR组术后全因病死率（OR= 0.72，95%CI：0.54～0.96）和主要心脑血管事件（MACCE，OR=0.54，95%CI：0.35～0.82）均低于CABG组。而在血运重 建（OR=0.90，95%CI：0.61～1.34）及心肌梗死或心绞痛发生率（OR=0.51，95%CI：0.18～1.41）方面差异无统计学意义。 （2）中期随访中 HCR 组的 MACCE 发生率低于 CABG 组（OR=0.31，95%CI：0.15～0.66），而全因病死率（OR=0.79， 95%CI：0.52～1.22）、血运重建（OR=0.77，95%CI：0.30～1.96）以及心肌梗死或心绞痛发生率（OR=0.71，95%CI：0.05～ 9.46）等差异无统计学意义。（3）远期随访中HCR组术后全因病死率（OR=0.67，95%CI：0.46～0.98）及心肌梗死或心绞 痛发生率（OR=0.32，95%CI：0.15～0.68）均低于 CABG 组。而在 MACCE（OR=0.72，95%CI：0.43～1.21）与血运重建 （OR=0.93，95%CI：0.60～1.45）方面差异无统计学意义。结论 HCR相比CABG可降低多支冠状动脉病变患者的中 期MACCE和远期全因病死率、心肌梗死或心绞痛发生率。

关键词: 冠状动脉疾病, 冠状动脉旁路移植术, 杂交冠状动脉血运重建术, 冠状动脉多支病变, 中远期随访, Meta分析

Abstract: Objective To systematically evaluate the long-term efficacy and complications of hybrid coronary artery revascularization (HCR) and coronary artery bypass grafting (CABG) in the treatment of the multiple coronary artery disease. Methods The databases of Embase, PubMed, Web of Science, Cochrane Central Registry of Controlled Trials (Central), Wanfang Data and China Knowledge Network were systematically searched. The documents that met the inclusion criteria were screened, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. RevMan 5.3 software was used for meta-analysis. Results Nine articles were included in the study. A total of 4 030 subjects were included, of which 1 142 were treated with HCR and 2 888 were treated with conventional CABG. Postoperative mortality (OR=0.72, 95%CI: 0.54- 0.96) and major cardiovascular and cerebrovascular events (MACCE, OR=0.54, 95%CI: 0.35-0.82) were lower in HCR group than those of CABG group in the mid- and long-term follow-up. There were no significant differences in the revascularization (OR=0.90, 95%CI: 0.61-1.34) and the incidence of angina (OR=0.51, 95%CI:0.18-1.41) between the two groups. In the midterm follow-up, the incidence of MACCE was lower in the HCR group than that in the conventional group (OR=0.31, 95%CI: 0.15-0.66), while there were no significant differences in the mortality (OR=0.79, 95%CI: 0.52-1.22),revascularization (OR=0.90, 95%CI: 0.61-1.34) and the incidence of myocardial infarction angina (OR=0.71, 95%CI: 0.05- 9.46) between the two groups. In the long-term follow-up, the postoperative mortality (OR=0.67, 95%CI: 0.54-0.96) and the incidence of myocardial infarction angina (OR=0.32, 95%CI: 0.15-0.68) were significantly lower in HCR group than those of the CABG group. There were no significant differences in MACCE (OR=0.72, 95%CI: 0.43-1.21) and revascularization (OR= 0.93, 95%CI: 0.60-1.45) between the two groups. Conclusion Compared with CABG, HCR can reduce the medium-term MACCE, long-term all-cause mortality and myocardial infarction/angina pectoris in patients with multi-vessel coronary artery disease.

Key words: coronary artery disease, coronary artery bypass grafting, hybrid coronary revascularization, coronary artery multivessel disease, medium and long-term follow-up: Meta-analysis