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首页> 外文期刊>Journal of cardiovascular medicine >Comparison of coronary artery bypass graft versus drug-eluting stents in dialysis patients: an updated systemic review and meta-analysis
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Comparison of coronary artery bypass graft versus drug-eluting stents in dialysis patients: an updated systemic review and meta-analysis

机译：透析患者冠状动脉旁路移植物与药物洗脱支架的比较：一个更新的全身评论和荟萃分析

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Introduction As percutaneous coronary intervention (PCI) technologies have been far improved, we hence conducted an updated systemic review and meta-analysis to determine the comparability between coronary artery bypass graft (CABG) and PCI with drug-eluting stent (DES) in ESRD patients. Methods We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED and the Cochrane from inception to January 2020. Included studies were published observational studies that compared the risk of cardiovascular outcomes among dialysis patients with CABG and DES. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Subgroup analyses and meta-regression were performed to explore heterogeneity. Results Thirteen studies were included in this analysis, involving total 56 422 (CABG 21 740 and PCI 34 682). Compared with DES, our study demonstrated CABG had higher 30-day mortality [odds ratio (OR) 3.85, P = 0.009] but lower cardiac mortality (OR 0.78, P < 0.001), myocardial infarction (OR 0.5, P < 0.001) and repeat revascularization (OR 0.35, P < 0.001). No statistical differences were found between CABG and DES for long-term mortality (OR 0.92, P = 0.055), composite outcomes (OR 0.88, P = 0.112) and stroke (OR 1.49, P = 0.457). Meta-regression suggested diabetes and the presence of left main coronary artery disease as an effect modifier of long-term mortality. Conclusion PCI with DES shared similar long-term mortality, composite outcomes and stroke outcomes to CABG among dialysis patients but still was associated with an improved 30-day survival. However, CABG had better rates of myocardial infarction, repeat revascularization and cardiac mortality.
机译：导言随着经皮冠状动脉介入治疗（PCI）技术的进步，我们进行了最新的系统回顾和荟萃分析，以确定ESRD患者冠状动脉旁路移植术（CABG）和带药物洗脱支架（DES）的PCI之间的可比性。方法综合检索MEDLINE、EMBASE、PUBMED和Cochrane数据库，时间从开始到2020年1月。纳入的研究是已发表的观察性研究，比较了接受CABG和DES的透析患者的心血管结局风险。使用DerSimonian和Laird的随机效应、通用逆方差方法结合每项研究的数据，计算风险比和95%置信区间。进行亚组分析和荟萃回归以探讨异质性。结果共纳入13项研究，涉及56422项（CABG21740和PCI 34682）。与DES相比，我们的研究表明CABG具有更高的30天死亡率[比值比（OR）3.85，P=0.009]，但心脏死亡率（OR 0.78，P<0.001）、心肌梗死（OR 0.5，P<0.001）和重复血运重建（OR 0.35，P<0.001）较低。CABG和DES在长期死亡率（OR 0.92，P=0.055）、综合结果（OR 0.88，P=0.112）和卒中（OR 1.49，P=0.457）方面没有发现统计学差异。荟萃回归显示糖尿病和左主干冠状动脉疾病是长期死亡率的影响因素。结论在透析患者中，PCI联合DES的长期死亡率、综合预后和卒中预后与CABG相似，但仍与改善30天生存率相关。然而，CABG具有更好的心肌梗死率、重复血运重建率和心脏死亡率。

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