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目的  比較冠狀動(dòng)脈旁路移植術(shù)（CABG）和經(jīng)皮冠狀動(dòng)脈介入術(shù)（PCI）對(duì)冠狀動(dòng)脈粥樣硬化性心臟?。ü谛牟。┖喜⒆笫沂湛s功能不全患者的臨床療效。 

方法 計(jì)算機(jī)檢索 PubMed、The Cochrane Library 及 EMbase數(shù)據(jù)庫，檢索時(shí)間為建庫至 2017 年 10 月。同時(shí)瀏覽相關(guān)文獻(xiàn)的引文目錄，納入符合要求的臨床試驗(yàn)、隊(duì)列研究和病例對(duì)照研究。本研究的終點(diǎn)包括全因死亡率、心肌梗死、再次血運(yùn)重建和卒中，其效應(yīng)量均用相對(duì)危險(xiǎn)度（RR）及其 95% 置信區(qū)間（CI）表示。 

結(jié)果  最終納入 15 項(xiàng)隊(duì)列研究和 2 項(xiàng)隨機(jī)對(duì)照試驗(yàn)，共計(jì)患者 11 985 例，其中 CABG 組 6 322 例，PCI 組 5 663 例。Meta 分析結(jié)果表明，CABG 組患者的全因死亡率低于 PCI 組患者（18.6% vs.23.0%），差異具有統(tǒng)計(jì)學(xué)意義［RR=0.87，95% CI（0.81，0.94），P<0.001］。CABG 組再次血運(yùn)重建的風(fēng)險(xiǎn)也顯著低于 PCI 組［RR=0.28，95% CI（0.19，0.42），P<0.001］，而兩組患者的心肌梗死［RR=0.78，95% CI（0.47，1.32），P=0.36］和卒中［RR=1.28，95% CI（0.89，1.86），P=0.18］的發(fā)生率無明顯差異。 

結(jié)論  CABG 治療冠心病合并左室收縮功能不全患者的療效優(yōu)于 PCI。鑒于納入研究的質(zhì)量限制，該結(jié)論尚需更多大樣本的隨機(jī)對(duì)照試驗(yàn)來進(jìn)一步驗(yàn)證。

Objective  To compare the clinical efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with coronary heart disease and left ventricular systolic dysfunction.

Methods A computer-based search in PubMed, The Cochrane Library and EMbase up to October 2017, together with reference screening, was performed to identify eligible clinical trials, cohort studies and case-control studies. The outcomes of this meta-analysis included all-cause mortality, myocardial infarction, revascularization and stroke, and the effect sizes for them were presented as relative risk (RR) with its 95% confidence intervals (CI).

Results Fifteen cohort studies and 2 randomized controlled trials were finally included with a total of 11 985 patients, of whom 6 322 were in the CABG group and 5 663 in the PCI group. The result of meta-analysis showed that all-cause mortality was significantly lower in the CABG group than that in the PCI group (18.6% vs. 23.0%, RR=0.87, 95% CI 0.81 to 0.94, P<0.001). In addition, CABG was associated with a remarkably reduced risk of revascularization (RR=0.28, 95% CI 0.19 to 0.42, P<0.001) compared with PCI, with no significant difference in incidence of myocardial infarction (RR=0.78, 95% CI 0.47 to 1.32, P=0.36) and stroke (RR=1.28, 95% CI 0.89 to 1.86, P=0.18).

Conclusion CABG is superior to PCI in the treatment for patients with coronary heart disease and left ventricular systolic dysfunction. Owing to the limited quality of included studies, additional large, randomized controlled trails are still required to confirm this finding.

  圖  

圖1  文獻(xiàn)篩選流程圖

圖2  全因死亡率的 Meta 分析

圖3  心肌梗死、再次血運(yùn)重建和卒中的 Meta 分析

全文見：www.tcsurg.org/article/10.7507/1007-4848.201712068