冠状动脉旁路手术与多血管疾病的皮肤冠状动脉干预相比:对来自十项随机试验的个人患者数据的合作分析
Mark A Hlatky1, Derek B Boothroyd, Dena M Bravata
1Stanford University School of Medicine, Stanford, CA, USA.
Lancet (London, England)
|March 24, 2009
概括
冠状动脉旁路移植 (CABG) 和皮肤冠状动脉干预 (PCI) 在大多数多血管冠状动脉疾病患者中显示出类似的长期死亡率. 然而,CABG可能为糖尿病患者和65岁或以上的患者提供更好的生存率.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心血管外科心血管外科
背景情况:
- 冠状动脉旁路移植 (CABG) 和皮肤冠状动脉干预 (PCI) 是多血管冠状动脉疾病的主要治疗方法.
- 在特定患者亚组中,CABG和PCI之间的长期死亡率差异仍然不清楚.
研究的目的:
- 协同分析随机试验数据,以比较CABG和PCI之间的长期死亡结果.
- 调查患者特征是否会改变治疗对死亡率的影响.
主要方法:
- 汇集了来自十项涉及7812名患者的随机试验的个人患者数据.
- 使用分层,随机效应的治疗意图分析. 考克斯比例危险模型.
- 检查了治疗对所有原因死亡率的影响及其与基线临床特征的相互作用.
主要成果:
- 在CABG和PCI之间,总体长期死亡率相似 (HR 0.91,p=0.12).
- 在糖尿病患者 (HR 0.70) 和65岁及以上患者 (HR 0.82) 中,CABG显示死亡率明显降低.
- 没有糖尿病的患者和65岁以下患者的治疗之间死亡率相似,糖尿病和年龄有显著的相互作用 (分别为p=0.014和p=0.002).
结论:
- 在大多数多血管冠状动脉疾病患者中,CABG和PCI的长期死亡率相似.
- 治疗决策应考虑患者对其他结果的偏好.
- 糖尿病患者和老年患者 (≥65岁) 可能更喜欢CABG,因为在这些群体中观察到的死亡率较低.
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