冠狀動脈旁路移植術治療無保護左主干病變療效及安全性系統評_《中國循證醫學雜志》

作者：

李俊紅 , 艾克拜爾 ,  木拉提 , Kamran Y Inamdar

新疆醫科大學第一附屬醫院心臟外科一科（烏魯木齊 830054）;

關鍵詞：

冠狀動脈旁路移植術經皮冠狀動脈支架置入術無保護左主干病變主要不良心腦血管事件 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20130188

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目的　系統評價冠狀動脈旁路移植術（CABG）與經皮冠狀動脈支架置入術（PCI）治療無保護左主干病變的療效及安全性。
方法　計算機檢索The Cochrane Library（2012年第2期）、PubMed、EMbase、CBM、CNKI、WanFang Data、VIP等數據庫，全面收集CABG與PCI比較治療無保護左主干病變的隨機對照試驗（RCT），檢索時限均為建庫至2012年9月，并追溯納入研究的參考文獻。由兩位研究者按照納入與排除標準獨立篩選文獻、提取資料和評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　納入4個RCT，共1 611例患者（CABG組：802例，PCI組：809例）。Meta分析結果顯示：與PCI組相比，CABG組能顯著降低術后靶血管血運重建率［OR=0.45，95%CI（0.31，0.66），P lt;0.000 1］，但在降低心肌梗死發生率［OR=1.28，95%CI（0.47，3.48），P=0.63］、病死率［OR=1.36，95%CI（0.80，2.34），P=0.26］及主要心腦血管事件發生率［OR=0.92，95%CI（0.66，1.28），P=0.61］方面，兩組差異無統計學意義。
結論　本系統評價結果提示，CABG在降低冠心病無保護左主干病變患者心梗發生率、病死率及主要心腦血管事件發生率方面與PCI差異無統計學意義，但在降低術后靶血管血運重建率方面，CABG療效優于PCI。受納入研究質量和數量所限，上述結論仍需開展更多高質量的RCT加以驗證。

引用本文： 李俊紅,艾克拜爾,木拉提,Kamran Y Inamdar. 冠狀動脈旁路移植術治療無保護左主干病變療效及安全性系統評. 中國循證醫學雜志, 2013, 13(9): 1096-1101. doi: 10.7507/1672-2531.20130188 復制

1.	Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004,110(8): 1168-1176.
2.	無保護左主干病變的選擇性支架協作組. 無保護左主干病變的選擇性支架術. 中華心血管病雜志, 2000,28(5): 346-348.
3.	Black A, Cortina R, Bossi I, et al. Unprotected left main coronary artery stenting: correlates of midterm survival and impact of patient selection. J Am Coll Cardiol, 2001, 37(3): 832-838.
4.	Taniyasu N, Akiyama K, Hirota J, et al. Newly developed left main coronary artery lesion after coronary stenting. J Cardiovasc Surg (Torino), 2002, 43(1): 55-88.
5.	Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation, 2010, 121(6): 2645-2653.
6.	Boudriot E, Thiele H, Walther T, et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am Coll Cardiol, 2011, 57(5): 538-545.
7.	Buszman PE, Kiesz SR, Bochenek A, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol, 2008, 51(5): 538-545.
8.	Park SJ, Kim YH, Park DW, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med, 2011, 364(18): 1718-1727.
9.	Garg S, Stone GW, Kappetein AP, et al. Clinical and angiographic risk assessment in patients with left main stem lesions. JACC Cardiovasc Interv, 2010, 3(9): 891-901.
10.	Chikwe J, Kim M, Goldstone AB, et al. Current diagnosis and management of left main coronary disease. Eur J Cardiothorac Surg, 2010, 38(10): 420-430.
11.	Kim YH, Park DW, Kim WJ, et al. Impact of the extent of coronary artery disease on outcomes after revascularization for unprotected left main coronary artery stenosis. J Am Coll Cardiol, 2010, 55(23): 2544-2552.
12.	Park DW, Kim YH, Song HG, et al. Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the Asan Medical Center-Multivessel Revascularization Registry. J Am Coll Cardiol, 2011, 57(2): 128-137.
13.	Celik T, Iyisoy A. The emerging role of percutaneous coronary intervention in the management of unprotected left main coronary artery disease: Ongoing debate. Int J Cardiol, 2010, 144(1): 90-91.
14.	Takagi H, Manabe H, Umemoto T. Percutaneous stenting versus bypass surgery for unprotected left main coronary artery disease. Am J Cardiol, 2010, 106(7): 1059.
15.	Lee MS, Bokhoor P, Park SJ, et al. Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention. JACC Cardiovasc Interv, 2010, 3(8): 791-795.
16.	Lee MS, Yang T, Dhoot J, et al. Meta-analysis of clinical studies comparing coronary artery bypass grafting with percutaneous coronary intervention and drug-eluting stents in patients with unprotected left main coronary artery narrowings. Am J Cardiol, 2010, 105(8): 1070-1075.
17.	Seung KB, Park DW, Kim YH, et al. Stents Versus coronary artery bypass grafting for left main comnary artery disease. N End J Med, 2008, 358(17): 1781-1792.
18.	White AJ, Kedia G, Mirocha JM, et al, Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis. JACC Cardiovasc Interv, 2008, 1(3): 236-245.
19.	Ghenim R, Roncalli J, Tidjane AM, et al. One-year follow-up of nonrandomized comparison between coronary artery bypass grafting surgery and drug-eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged >or=75 years). J Interv Cardiol, 2009, 22(6): 520-526.
20.	Shimizu T, Ohno T, Ando J, et al. Mid-term results and costs of coronary artery bypass vs drug-eluting stents for unprotected left main coronary artery disease. Circ J, 2010, 74(3): 449-455.
21.	Serruys PW, Moriee MC, Kappetein AP, et al. Pereutaneous Coronary Intervention versus Coronary-Artery ByPass Grafting for Severe Coronary Artery Disease. N Engl J Med, 2009, 360(10): 961-972.
22.	Naik H, White AJ, Chakravarty T, et al. A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis. JACC Cardiovasc Interv, 2009, 2(8): 739-747.
23.	Palmerini T, Barlocco F, Santarelli A, et al. A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged 75 years). Eur. Heart J, 2007, 28(22): 2714-2719.
24.	Mclellan CS, Ghali WA, Labinaz M, et al. Association between completeness of percutaneous coronary revascularization and postprocedure outcomes. Am Heart J, 2005, 150(4): 800-806.

1. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004,110(8): 1168-1176.
2. 無保護左主干病變的選擇性支架協作組. 無保護左主干病變的選擇性支架術. 中華心血管病雜志, 2000,28(5): 346-348.
3. Black A, Cortina R, Bossi I, et al. Unprotected left main coronary artery stenting: correlates of midterm survival and impact of patient selection. J Am Coll Cardiol, 2001, 37(3): 832-838.
4. Taniyasu N, Akiyama K, Hirota J, et al. Newly developed left main coronary artery lesion after coronary stenting. J Cardiovasc Surg (Torino), 2002, 43(1): 55-88.
5. Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation, 2010, 121(6): 2645-2653.
6. Boudriot E, Thiele H, Walther T, et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am Coll Cardiol, 2011, 57(5): 538-545.
7. Buszman PE, Kiesz SR, Bochenek A, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol, 2008, 51(5): 538-545.
8. Park SJ, Kim YH, Park DW, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med, 2011, 364(18): 1718-1727.
9. Garg S, Stone GW, Kappetein AP, et al. Clinical and angiographic risk assessment in patients with left main stem lesions. JACC Cardiovasc Interv, 2010, 3(9): 891-901.
10. Chikwe J, Kim M, Goldstone AB, et al. Current diagnosis and management of left main coronary disease. Eur J Cardiothorac Surg, 2010, 38(10): 420-430.
11. Kim YH, Park DW, Kim WJ, et al. Impact of the extent of coronary artery disease on outcomes after revascularization for unprotected left main coronary artery stenosis. J Am Coll Cardiol, 2010, 55(23): 2544-2552.
12. Park DW, Kim YH, Song HG, et al. Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the Asan Medical Center-Multivessel Revascularization Registry. J Am Coll Cardiol, 2011, 57(2): 128-137.
13. Celik T, Iyisoy A. The emerging role of percutaneous coronary intervention in the management of unprotected left main coronary artery disease: Ongoing debate. Int J Cardiol, 2010, 144(1): 90-91.
14. Takagi H, Manabe H, Umemoto T. Percutaneous stenting versus bypass surgery for unprotected left main coronary artery disease. Am J Cardiol, 2010, 106(7): 1059.
15. Lee MS, Bokhoor P, Park SJ, et al. Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention. JACC Cardiovasc Interv, 2010, 3(8): 791-795.
16. Lee MS, Yang T, Dhoot J, et al. Meta-analysis of clinical studies comparing coronary artery bypass grafting with percutaneous coronary intervention and drug-eluting stents in patients with unprotected left main coronary artery narrowings. Am J Cardiol, 2010, 105(8): 1070-1075.
17. Seung KB, Park DW, Kim YH, et al. Stents Versus coronary artery bypass grafting for left main comnary artery disease. N End J Med, 2008, 358(17): 1781-1792.
18. White AJ, Kedia G, Mirocha JM, et al, Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis. JACC Cardiovasc Interv, 2008, 1(3): 236-245.
19. Ghenim R, Roncalli J, Tidjane AM, et al. One-year follow-up of nonrandomized comparison between coronary artery bypass grafting surgery and drug-eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged >or=75 years). J Interv Cardiol, 2009, 22(6): 520-526.
20. Shimizu T, Ohno T, Ando J, et al. Mid-term results and costs of coronary artery bypass vs drug-eluting stents for unprotected left main coronary artery disease. Circ J, 2010, 74(3): 449-455.
21. Serruys PW, Moriee MC, Kappetein AP, et al. Pereutaneous Coronary Intervention versus Coronary-Artery ByPass Grafting for Severe Coronary Artery Disease. N Engl J Med, 2009, 360(10): 961-972.
22. Naik H, White AJ, Chakravarty T, et al. A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis. JACC Cardiovasc Interv, 2009, 2(8): 739-747.
23. Palmerini T, Barlocco F, Santarelli A, et al. A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged 75 years). Eur. Heart J, 2007, 28(22): 2714-2719.
24. Mclellan CS, Ghali WA, Labinaz M, et al. Association between completeness of percutaneous coronary revascularization and postprocedure outcomes. Am Heart J, 2005, 150(4): 800-806.

《中國循證醫學雜志》

冠狀動脈旁路移植術治療無保護左主干病變療效及安全性系統評

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《中國循證醫學雜志》

冠狀動脈旁路移植術治療無保護左主干病變療效及安全性系統評

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