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冠状动脉旁路移植手术与冠状动脉再血管化的皮肤间干预:系统性审查
Saswata Deb1, Harindra C Wijeysundera, Dennis T Ko
1Schulich Heart Centre, Division of Cardiology and Cardiac Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada2Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA
|November 19, 2013
概括
冠状动脉旁路移植 (CABG) 手术是建议通过皮肤冠状动脉干预 (PCI) 复杂冠状动脉疾病,特别是在糖尿病患者. 心脏团队的方法对于选择最佳的复血管化策略至关重要.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 缺血性心脏病是全球主要的死亡原因.
- 冠状动脉旁路移植 (CABG) 手术和皮肤冠状动脉干预 (PCI) 是主要的重血管化方法.
- 对于特定的患者群体来说,最佳的再血管化选择仍然存在争议.
研究的目的:
- 为了比较CABG手术与PCI的有效性.
- 专注于没有保护的左主疾病 (ULMD),多血管冠状动脉疾病 (CAD),糖尿病或左心室功能障碍 (LVD) 的患者.
主要方法:
- 随机临床试验 (RCT) 和元分析的系统审查.
- 从2007年1月到2013年6月的文献搜索.
- 评估结果:死亡率和主要心脏和脑血管不良事件 (MACCE).
主要成果:
- 对于复杂的ULMD,多血管CAD或LVD (SYNTAX分数>22) 进行CABG手术是最受欢迎的.
- 对于不那么复杂的疾病 (SYNTAX ≤22) 或高手术风险而考虑的PCI.
- 推CABG手术治疗多血管CAD糖尿病,因为长期存活率优越 (5年MACCE:18.7%对比26.6%).
- 在PCI中,重复血管化率更高;在CABG手术中,中风率更高.
结论:
- CABG手术和PCI都适用于高级CAD.
- CABG手术为糖尿病患者提供了更好的结果.
- 在ULMD,多血管CAD或LVD的复杂病变/解剖学中偏好CABG;在不那么复杂的疾病或高手术风险中偏好PCI.
- 一个心脏团队的方法是必不可少的,考虑到疾病的复杂性,患者因素和当地专业知识.
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