高龄患者冠状动脉旁路移植术与置入药物洗脱支架术后近远期疗效比较的Meta分析

A Meta-Analysis of Near-Long-Term Efficacy of Coronary Artery Bypass Grafting and Drug-Eluting Stent in Elderly Patients

摘要: 目的:系统评价高龄(年龄 ≥ 75岁)患者冠状动脉旁路移植术(coronary artery bypass grafting, CABG)与行经皮冠状动脉介入(percutaneous coronary intervention, PCI)下置入药物洗脱支架(drug eluting stent, DES)术后近远期疗效。方法：利用计算机检索MEDLINE(via pubmed，建库至2017年2月)、EMBASE (建库至2017年2月)、Cochrane Library (建库至2017年2月)，并辅助以手动检索会议记录或灰色文献，收集研究高龄患者CABG与PCI下置入DES术后死亡率、主要不良心脑血管事件(main adverse cardiovascular and cerebrovascular events, MACCE)、心肌梗死(myocardial infarction, MI)以及靶病变再次血运重建(target lesion revascularization, TLR)发生率对比的英文文献资料。采用Review Manager 5.3软件进行meta分析。结果：共纳入12篇文献进入meta分析，均为观察性研究，未检索到随机对照研究(randomized controlled study, RCT)。本meta分析共纳入6877例患者，其中CABG组3460例(50.31%)。Meta分析结果表明：两组患者术后远期死亡率(OR = 1.29, 95%CI (1.07, 1.57), P = 0.009)以及TLR发生率(OR = 5.88, 95%CI (4.68,7.38), P < 0.00001)的差异具有统计学意义，院内死亡率(OR = 0.78, 95%CI (0.56,1.08), P = 0.14)、MACCE发生率(OR = 1.01, 95%CI (0.88, 1.17), P = 0.87)以及MI发生率(OR = 1.25, 95%CI (0.68, 2.30), P = 0.46)差异不具有统计学意义。结论：与PCI相比，CABG能明显减低高龄患者术后远期死亡率以及血运重建发生率，但仍有待于更多更大的随机对照试验以进一步验证。

Abstract: Objective: To evaluate the near-long-term efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in the elderly (age ≥ 75 years). Methods: We searched relevant literatures in MEDLINE (via pubmed), EMBASE, Cochrane Library from the time of building to 2017. Meanwhile, we collected conference records or gray literature from cardiovascular con-gresses to compare CABG and PCI for elderly patients. Meta analysis was performed using Review Manager 5.3 software. Results: A total of 12 articles were included in the meta-analysis, all of which were observational studies and randomized controlled studies (RCTs) were not retrieved. A total of 6877 patients were enrolled in this meta-analysis, of which 3460 (50.31%) were CABG. Meta- anal-ysis showed that the long-term mortality rate (OR = 1.29, 95% CI (1.07, 1.57), P = 0.009) and the in-cidence rate of revascularization (OR = 5.88, 95% CI (4.68, 7.38), P < 0.00001) have significant dif-ference between CABG group and PCI group. However, in-hospital mortality rate (OR = 0.78, 95% CI (0.56, 1.08), P = 0.14), the incidence rate of MACCE (OR = 1.01, 95% CI (0.88, 1.17), P = 0.87) and the incidence rate of MI (OR = 1.25, 95% CI (0.68, 2.30), P = 0.46) have not significant difference be-tween CABG group and PCI group. Conclusions: Compared with PCI, CABG can reduce the long-term mortality rate and the incidence rate of TLR in elderly patients, but more and more randomized controlled trials are still needed for further verification.